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June 2011
Pregnancy Outcome Unit,
Epidemiology Branch, SA Health
Pregnancy
Outcome
in South Australia
2009
June 2011
Pregnancy Outcome in South Australia 2009
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: Chan A, Scheil W, Scott J, Nguyen A-M, Sage L. Pregnancy Outcome in South Australia 2009.
Adelaide: Pregnancy Outcome Unit, SA Health, Government of South Australia, 2011.
Pregnancy Outcome in
South Australia 2009
Annabelle Chan
Wendy Scheil
Joan Scott
Anh-Minh Nguyen
Leonie Sage
June 2011
Pregnancy Outcome Unit
SA Health
Staff
Annabelle Chan Head/Senior medical consultant to July 2010
Clinical Associate Professor, Discipline of Obstetrics and
Gynaecology, University of Adelaide
Wendy Scheil Acting Head/Senior medical consultant from August 2010
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 like to congratulate Associate Professor Annabelle Chan on her retirement and thank her most sincerely for
her many years of dedicated work with the Pregnancy Outcome Unit since 1986.
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 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 2009page 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 ........................................................................................... 10
7. Antenatal care and length of stay ................................................................................................................... 11
8. Aboriginal women ........................................................................................................................................ 11i
9. Procedures ..................................................................................................................................................... 11
10. Method of birth ........................................................................................................................................... 11
11. Multiple births .............................................................................................................................................. 11
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 and 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 ............................................................................................................................................. 23
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 2009 page 3
Contents
14b. Reasons for induction of labour .................................................................................................................. 32
15a. Presentation and method of birth ............................................................................................................... 33
15b. Reason for caesarean section ..................................................................................................................... 34
16. Complications of labour and birth and perineal status after birth .................................................................. 36
17. Fetal monitoring during labour ..................................................................................................................... 36
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 ..................................................................................................................................... 41
25. Length of stay of babies ............................................................................................................................... 41
26. Congenital anomalies ................................................................................................................................... 42
27. Multiple births .............................................................................................................................................. 43
28. Perinatal mortality ........................................................................................................................................ 44
29. Home births ................................................................................................................................................. 46
30. Birthing unit births ....................................................................................................................................... 48
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 abortion rate and Total first abortion rate ............................................................ 55
IV. Obstetric Profiles by Hospital Category 57
V. Clinical and Maternity Performance Indicators 67
1. Clinical indicators ........................................................................................................................................... 67
2. Maternity performance indicators, hospitals with at least 500 births per year ................................................. 70
VI. Trends in Perinatal Statistics in South Australia,1981 2009 74
Trends in Perinatal Statistics in South Australia (SA), 1985 2009 ....................................................................... 74
VII. Summary statistics for 2009 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
Pregnancy Outcome in South Australia 2009page 4
Contents
6. Obstetric interventions in 19,604 women who gave birth ............................................................................... 81
7. Low birthweight (<2,500g) ............................................................................................................................ 81
8. Congenital abnormalities ............................................................................................................................... 81
9. Perinatal morality rates (numbers of deaths in parentheses) ............................................................................ 81
10. Terminations of pregnancy ........................................................................................................................... 81
References 82
Publications 82
Annual Reports ................................................................................................................................................. 82
Other reports/papers .......................................................................................................................................... 83
Appendix 1: Definitions 89
Appendix 2: 2009 Supplementary Birth Record Form 93
Appendix 3: Congenital Abnormality Form 94
Tables
Table 1: Births and crude birth rate by CURB regions, South Australia, 2009 ........................................ 14
Table 2: Total births notified in 2009, by place of birth and plurality, South Australia ......................... 15
Table 3a: Hospital births by category of hospital, South Australia, 2009 ................................................. 17
Table 3b: Hospital births in South Australia in 2009 by race and hospital ...........................................18-19
Table 4a: Race of women who gave birth, South Australia, 2009 ............................................................. 20
Table 4b: Race and birthplace category of women who gave birth, South Australia, 2009 ................... 20
Table 4c: Age and race of women who gave birth, South Australia, 2009 .............................................. 21
Table 4d: Age-specific fertility rates, South Australia, 2009 ...................................................................... 22
Table 5a: Country of birth, major groups,* women who gave birth, South Australia, 2009 .................. 23
Table 5b: Specified country of birth,* women who gave birth, South Australia, 2009 ........................... 23
Table 6a: Marital status and age, women who gave birth, South Australia, 2009 .................................. 24
Table 6b: Type of patient and marital status, women who gave birth, South Australia, 2009 ............... 24
Table 7: Occupation* of father and mother, women who gave birth, South Australia, 2009 .............. 25
Table 8a: Parity by race, women who gave birth, South Australia, 2009 ................................................. 26
Table 8b: Previous pregnancy outcomes, women who gave birth, South Australia, 2009
(multigravidae only, n= 13,712) ................................................................................................... 26
Table 9a: Gestation at first antenatal visit, women who gave birth, by race, South Australia, 2009
(n=19,604) ..................................................................................................................................... 27
Table 9b: BMI of women who gave birth, South Australia, 2009 .............................................................. 27
Pregnancy Outcome in South Australia 2009 page 5
Tables
Table 9c: Antenatal visits by race, women who gave birth, South Australia, 2009 ................................. 28
Table 9d: Type of antenatal care, women who gave birth, South Australia, 2009 (n = 19,604) .............. 28
Table 10a: Tobacco smoking status at first antenatal visit, non-Aboriginal and Aboriginal women
who gave birth, South Australia, 2009 ........................................................................................ 29
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, 2009 ..................... 29
Table 11: Medical conditions in current pregnancy, women who gave birth, South Australia, 2009 ..... 30
Table 12: Frequency of some obstetric complications, women who gave birth, South Australia, 2009 ....30
Table 13: Procedures performed in current pregnancy, women who gave birth, South Australia, 2009 ..31
Table 14a: Onset of labour, women who gave birth, South Australia, 2009 .............................................. 31
Table 14b: Method of induction of labour, women who gave birth, South Australia, 2009 ..................... 31
Table 14c: Augmentation of labour after spontaneous onset, women who gave birth,
South Australia, 2009 ................................................................................................................... 32
Table 15a: Method of birth, women who gave birth, South Australia, 2009 ............................................. 33
Table 15b: Method of birth by presentation, all births, South Australian 2009 (n=19,901) ...................... 34
Table 15c: Method of birth in breech presentation, by plurality, all births, South Australia,
2009 (n = 941) ............................................................................................................................... 34
Table 16: Frequency of some complications of labour and birth, women who gave birth,
South Australia, 2009 ................................................................................................................... 36
Table 17a: CTG performed during labour, women who gave birth, South Australia, 2009 ...................... 36
Table 17b: Fetal scalp pH taken during labour, women who gave birth, South Australia, 2009 .............. 36
Table 18a: Analgesia for labour,* women who gave birth, South Australia, 2009 .................................... 37
Table 18b: Anaesthesia for birth,* women who gave birth, South Australia, 2009 ................................... 37
Table 19a: Postnatal length of stay by type of patient, women who gave birth in South Australian
hospitals, 2009 .............................................................................................................................. 38
Table 19b: Average postnatal length of stay by type of patient & type of birth, women who gave
birth in South Australian hospitals, 2009 .................................................................................... 38
Table 20: Sex of baby, all births, South Australia, 2009 ............................................................................. 39
Table 21: Birthweight distribution of all births, South Australia, 2009 .................................................... 39
Table 22: Birth injuries* in 19,761 live births, South Australia, 2009 ........................................................ 40
Table 23: Neonatal treatment given, all live births, South Australia, 2009 .............................................. 40
Table 24: Level of nursery care utilised by birthweight, all live births, South Australia, 2009 ................ 41
Table 25: Length of stay of liveborn babies in hospital, South Australia, 2009 ....................................... 41
Table 26: Selected congenital abnormalities notified to the perinatal statistics collection,
1999-2009, South Australia ......................................................................................................... 42
Table 27a: Birthweight by plurality, all births, South Australia, 2009 ......................................................... 43
Table 27b: Gestation at birth by plurality all births, South Australia, 2009 ................................................ 43
Pregnancy Outcome in South Australia 2009page 6
Tables
Table 27c: Perinatal outcome by plurality, all births, South Australia, 2009 .............................................. 44
Table 28a: Perinatal mortality by birthweight, all births, South Australia, 2009 ....................................... 44
Table 28b: Perinatal mortality by gestational age at birth, South Australia, 2009 .................................... 45
Table 28c: Perinatal mortality, South Australia, 2009 (all births of specified birthweight/gestation) ...... 46
Table 28d: Perinatal mortality by race, all births, South Australia, 2009 .................................................... 46
Table 29: Planned home births by age of women, South Australia, 2009 ................................................ 47
Table 30: Method of birth in planned home births, South Australia, 2009 .............................................. 47
Table 31: Birthweight distribution of planned home births, South Australia, 2009 ................................ 47
Table 32: Perinatal outcome in planned home births, South Australia, 2009 .......................................... 47
Table 33: Planned birthing unit births by age of women, South Australia, 2009 .................................... 48
Table 34: Method of birth in planned birthing unit births, South Australia, 2009 .................................. 48
Table 35: Birthweight distribution of planned birthing unit births, South Australia, 2009 .................... 49
Table 36: Perinatal outcome in planned birthing unit births, South Australia, 2009 .............................. 49
Table 37: Abortion rate per 1,000 women aged 15-44 years, South Australia, 1970-2009 ...................... 50
Table 38: Terminations of pregnancy by age, South Australia, 2009 ........................................................ 51
Table 39: Abortion and live birth rates and abortion proportions by age, South Australia, 2009 ......... 52
Table 40: Terminations by place of residence, South Australia, 2009 ....................................................... 53
Table 41: Terminations by hospital category, South Australia, 2009 ......................................................... 53
Table 42: Terminations by category of doctor, South Australia, 2009 ....................................................... 53
Table 43: Reason for termination for fetal reasons, South Australia, 2009 .............................................. 54
Table 44: Complications of terminations, South Australia, 2009 ............................................................... 54
Table 45a: Women with previous terminations by age, South Australia, 2009 .......................................... 55
Table 45b: Calculation of total abortion rate (TAR) for 2009 for South Australia* ................................... 56
Table 45c: Calculation of total first abortion rate (TFAR) for 2009 for South Australia* .......................... 56
Table 46: Obstetric profiles by hospital category, South Australia, 2009: live births of any gestation
and stillbirths of >=400g or >=20 weeks gestation .................................................................... 59
Table 47: Socio-demographic aspects of perinatal statistics, South Australia, 1981 and 2000 2009 ....75
Table 48: Obstetric aspects of perinatal statistics, South Australia, 1981 and 2000 2009 ..................... 76
Pregnancy Outcome in South Australia 2009 page 7
Tables
Figures
Figure 1a: Map showing SA hospitals with obstetric beds in 2009 ............................................................ 15
Figure 1b: Map showing Central Regions of SA .......................................................................................... 16
Figure 2: Distribution of hospital births by hospital category, South Australia, 2009 (n=19,766) ......... 17
Figure 3: Age and race of women who gave birth, 2009 (n=19,604) ...................................................... 22
Figure 4: Reasons for induction of labour, SA, 2009 (n=5,770) ................................................................ 32
Figure 5a: Method of birth, women who gave birth, South Australia, 2009 (n = 19,604) ....................... 33
Figure 5b: Reason for caesarean section, 2009 (n=6,357) ........................................................................... 35
Figure 5c: Reason for elective caesarean section, 2009 (n=3,084) ............................................................. 35
Figure 5d: Reason for emergency caesarean section, 2009 (n=3,273) ........................................................ 35
Figure 6: Perinatal mortality rate by birthweight, all births, South Australia, 2009 ............................... 45
Figure 7: Abortion rate in South Australia, 1970-2009 ............................................................................. 51
Figure 8a: Abortions and live births by age, South Australia, 2009 ........................................................... 52
Figure 8b: Teenage pregnancy, abortion and birth rates, South Australia, 1970-2009 ............................ 53
Figure 9: Percentage of Aboriginal women by hospital category ........................................................... 60
Figure 10: Percentage of women with <7 antenatal visits by hospital category ...................................... 60
Figure 11: Percentage of teenage women by hospital category ............................................................... 60
Figure 12: Percentage of women 35 years or more by hospital category ................................................. 61
Figure 13: Percentage of single women by hospital category ................................................................... 61
Figure 14: Percentage of women with 4 or more prior livebirths by hospital category ........................... 61
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 .............................. 62
Figure 17: Percentage of women with complications during labour or birth by hospital category ........ 62
Figure 18: Percentage of women with induction of labour by hospital category .................................... 63
Figure 19: Percentage of women having epidural analgesia by hospital category .................................. 63
Figure 20: Percentage of breech births by hospital category ..................................................................... 63
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 ................................................... 64
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 ............................ 65
Figure 27: Percentage of live births requiring neonatal intensive care by hospital category .................. 66
Pregnancy Outcome in South Australia 2009page 8
Figures
Figure 28: Percentage of births with birth defects by hospital category .................................................. 66
Figure 29a: Induction of labour proportion for selected primiparae, SA hospitals with >=500 births
per year, 2009 ............................................................................................................................... 71
Figure 29b: Caesarean section rate for selected primiparae, SA hospitals with >=500 births
per year, 2009 ............................................................................................................................... 71
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, 2009 ..................................................................................................................................... 72
Figure 29d: PRIMIP no repair: proportion of primiparous women not requiring surgical repair
following vaginal birth, SA hospitals with >=500 births per year, 2009 .................................. 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, 2009 .................................. 72
Figure 29f: SPMR (Standardized Perinatal Mortality Ratio) for all births, SA hospitals
with >=500 births per year, 2009 ................................................................................................ 73
Figure 29g: SPMR (Standardized Perinatal Mortality Ratio) for all births, SA hospitals
with >=500 births per year, 2005-2009 ....................................................................................... 73
Figure 30a: Percentage of teenage women among women giving birth in SA .......................................... 77
Figure 30b: Percentage of women aged 35 years and over among women giving birth in SA ................. 77
Figure 30c: Percentage of primiparous women aged 35 years and over in SA ........................................... 77
Figure 30d: Percentage of Aboriginal women and Asian women among women giving birth in SA ....... 78
Figure 30e: Percentage of women never married and with no de facto partner among
women giving birth in SA ........................................................................................................... 78
Figure 30f: Percentage of multiple births among births in SA .................................................................... 78
Figure 30g: Percentage of low birthweight babies among births in SA ...................................................... 79
Figure 30h: SA standardised perinatal mortality ratio (SPMR) ..................................................................... 79
Pregnancy Outcome in South Australia 2009 page 9
Figures
Executive Summary
This Report on pregnancy outcome in South Australia for 2009 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 2009 are available in the Seventh Annual Report of the
Abortion Reporting Committee. Comparisons of selected pregnancy characteristics and outcomes are provided for
five different hospital categories in the state. Individual hospital reports (Pregnancy and Neonatal Care Bulletins) with
these comparisons made in greater detail are provided to hospitals in the state with at least 100 births per year. Group
reports are 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 2009 was 19,901, which was 69 fewer than the previous year.
The number of women who gave birth was 19,604. The total fertility rate was 1.87 live births per woman, a decrease
from 1.91 in 2007 and 2008. The fertility rate decreased slightly in all age groupings other than the 25-29 years age
grouping which remained stable and there was a slight increase in the group of women aged 40-45 years.
2. Place of birth
The numbers of births increased at Flinders Medical Centre and the Lyell McEwin Hospital and decreased at the
Women s and Children s Hospital. Births decreased at metropolitan private hospitals. Six percent of women (1,166
women) gave birth in birthing units in teaching hospitals and 125 women (0.6%) had planned home births.
3. Teenage women
811 teenage women gave birth, accounting for 4.1% of women who gave birth, and 912 teenage women had
terminations of pregnancy, accounting for 18.0% of terminations. In 2009, the proportion of known pregnancies
terminated was 52.9% 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 32.7 per 1,000 women in 2009 was the lowest rate recorded since 1970.
4. Older women and first time mothers
The mean age of women giving birth increased from 26.55 years in 1981 to 30.14 years in 2009, and, among first
time mothers, from 24.42 years to 28.27 years. The proportion of women aged 35 years or more increased from
4.6% in 1981 to 21.1% in 2009. Among first time mothers, this proportion increased from 1.2% to 12.8%. As in
the previous seven 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-one percent of women who gave birth in 2009 were Australian-born. Of women born overseas who gave birth,
the largest proportions came from the United Kingdom and Ireland (2.9% of women), India (1.9%), Vietnam (1.3%),
New Zealand and China (1.1% each), the Philippines (1.0%) and Sudan (0.7%). Eight percent of women (1,585 women)
who gave birth in the state in 2009 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 16% in 2009.
About 4% each year quit smoking before the first antenatal visit.
While statistics on Body Mass Index were available only for 68% of women who gave birth in 2009 (an improvement
from 42% in 2007), and must be interpreted with caution, these show that 27% of women were overweight and
23% were obese, including 10% who were severely or morbidly obese.
Pregnancy Outcome in South Australia 2009page 10
Executive Summary
7. Antenatal care and length of stay
Statistics on gestation at first antenatal visit were available only for 89% of women who gave birth. These show that
78% of women attended for antenatal care within the first 14 weeks of pregnancy. Nearly 92% attended at least
seven antenatal visits. Although many women had more than one type of antenatal care, the most common types
used were hospital clinics (45%), obstetricians in private practice (32%) and general practitioners (17%). Thirty-two
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 five days for those who had a caesarean section. Amongst private
patients, hospital stay was two days longer for vaginal births and one day longer for caesarean births.
8. Aboriginal women
607 Aboriginal women gave birth in South Australia in 2009, accounting for 3.1% of all women who gave birth in
the state. Twenty percent of Aboriginal women were teenagers (compared with 3.6% of non-Aboriginal women).
Fifty-one percent of Aboriginal women attended for antenatal care within the first 14 weeks of pregnancy (compared
with 79% of non-Aboriginal women) and 68% attended at least seven antenatal visits during pregnancy (compared
with 92% of non-Aboriginal women). While the proportion of non-Aboriginal women smoking during pregnancy
declined steadily from 24% in 1998 to 15% in 2009, no similar decline was observed in Aboriginal women. However,
in 2009 Aboriginal women recorded their lowest level of smoking during pregnancy of 52%, although this was higher
than for non-Aboriginal women (15%). In 2009 their proportions of preterm births (<37 weeks gestation), and low
birthweight births (<2,500g), remained nearly twice as high as those of non-Aboriginal births. The perinatal mortality
rate of babies of Aboriginal women was the second lowest recorded, but remained higher than that of babies of non-
Aboriginal women (14.6 compared with 9.3 per 1,000 births).
9. Procedures
Ninety-eight percent of women who gave birth had an ultrasound examination; 29% had labour induced while
another 22% had spontaneous labour augmented; epidurals were used for pain relief during labour for 31% of
women, and 11% had an episiotomy (17% of women who gave birth vaginally). The main reasons for induction
of labour were prolonged pregnancy (20%), hypertension (14%), diabetes or gestational diabetes (8%), poor
fetal growth (6%) and premature rupture of membranes (3.7%). Fifty-three 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 4.6%
by forceps (compared with 1% and 15% respectively in 1981). In 2009 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 17% 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 (39%), failure to progress in labour or cephalopelvic disproportion
(27%), fetal distress (16%) and malpresentation (12%).
11. Multiple births
Multiple births accounted for 3.0% of births; women with twins or triplets accounted for 1.5% of women who gave
birth in 2009. 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.
However, 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.
Pregnancy Outcome in South Australia 2009 page 11
Executive Summary
12. Abortions
5,054 terminations of pregnancy were notified, 47 less than in 2008. The abortion rate was 15.6 per 1,000 women
aged 15-44 years, a slight decrease from 2008 (16.0 per 1,000 women aged 15-44 years). The rate has declined
significantly since 2001, when it was 17.7 per 1,000 women. Approximately 93% 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% (90) were performed at or after 20 weeks gestation. Fifty-four percent of terminations
performed at or after 20 weeks gestation were for fetal abnormalities. Approximately 21% of reported pregnancies
ended as terminations in 2009.
13. Perinatal mortality
The perinatal mortality rate for all births in 2009 was 9.5 per 1,000 births, the stillbirth rate was 7.0 per 1,000
births and the neonatal mortality rate was 2.5 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 2009 was 3.5 per 1,000 births,
with an early neonatal mortality rate of 0.9 per 1,000 live births.
14. Congenital Anomalies
In 2009 there were 539 births (2.7%) notified at birth with congenital anomalies, compared with an average of 2.5%
over the past decade. In 2009 the number of spina bifida cases reported at birth increased from 4 cases in 2008 to 18
in 2009. No reason for this recent sudden increase can be determined. 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. It is important that all women are advised to use supplementary folate when planning
to conceive and in early pregnancy.
Pregnancy Outcome in South Australia 2009page 12
Executive Summary
I. Introduction
This Report summarizes the statistics for 2009 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 2009.3
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 2009 page 13
Introduction
II. Mothers and Babies: Characteristics & Outcomes
The births in 2009 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. Sixty four births of less than 400g birthweight have been included, consisting of 52 stillbirths and twelve
live births. The twelve live births were born at 18-25 weeks gestation and all but premature twins died in the neonatal
period. SBRs were received for all 19,901 births reported by hospital and home birth midwives in their monthly
notification lists. These comprised 19,761 live births and 140 stillbirths. The number of women who gave birth was
19,604, 68 less women than in 2008. 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 2009 for South Australia was 12.3 per 1,000 population. It
was lowest in the Murraylands and the Central Eastern Regions. It was highest in the Central Northern Region and
was also high in the Northern and Eyre.
Table 1: Births and crude birth rate by CURB regions, South Australia, 2009
CURB Region
(Mother s residence) Total births Live births
Estimated resident
population,
June 30, 2009+
Crude birth
rate per 1,000
population
Number Percent Number Number
Central Northern 6,041 30.4 5,997 428,080 14.1
Central Western 2,476 12.4 2,453 223,538 11.1
Central Eastern 3,068 15.4 3,051 285,582 10.7
Central Southern 4,500 22.6 4,471 386,889 11.6
Yorke & Lower North 499 2.5 499 47,052 10.6
Murraylands 811 4.1 800 70,426 11.5
South East 839 4.2 835 65,978 12.7
Northern 1,053 5.3 1,046 80,489 13.1
Eyre 495 2.5 493 35,556 13.9
Interstate 119 0.6 116 na na
Total 19,901 100.0 19,761 1,623,590 12.3
+ Australian Bureau of Statistics. Population estimates by age and sex, South Australia, 2009. Canberra: ABS, 2010 (Catalogue No 3235.0).
na: not applicable
Pregnancy Outcome in South Australia 2009page 14
Mothers and Babies
2. Place of birth of baby
Of the 19,901 births in 2009, 134 (0.7%) were home births and of those 125 were planned homebirths. The place
of birth of one baby, who died in the perinatal period, was not known. The remaining 19,766 births occurred in
hospitals or (in 76 cases) before arrival at hospitals into which the women had been booked. These 76 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
2009 are provided in Figures 1A and 1B.
Table 2: Total births notified in 2009, by place of birth and plurality, South Australia
Condition at birth
Home births Hospital births
Total
Singleton Twin Singleton Twin Triplet
Live birth 133 0 19,047 569 12 19,761
Stillbirth 1 0 129 9 0 139
Total births 134 0 19,176 578 12 19,901*
*includes one stillbirth for whom the place of birth was not known
Figure 1a: Map showing SA hospitals with obstetric beds in 2009
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
100-399 births per annum
< 100 births per annum
* The six centres near the
north-western border
are Aboriginal clinics
Pregnancy Outcome in South Australia 2009 page 15
Mothers and Babies
Of the 19,766 hospital births, 79.9% occurred in metropolitan hospitals (teaching and private) and 20.1% in country
hospitals. This distribution is summarized 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-four percent of births in South Australia
in 2009 occurred in metropolitan teaching hospitals. Level III teaching hospitals - the Women s and Children s Hospital
and Flinders Medical Centre - provide a high risk pregnancy service and neonatal intensive care. The Lyell McEwin
Hospital has a special care (Level II) neonatal unit. These levels are defined in the Report Operational Policy, Guidelines
and Standards for Maternal and Neonatal Services in South Australia. 4
Compared with 2008, births increased at the Lyell McEwin Hospital and Flinders Medical Centre, while births at the
Women s and Children s Hospital decreased. The total number of births in metropolitan private hospitals decreased
slightly, with only the North Eastern Community Hospital showing a small increase. Births at Calvary remained constant.
The total number of births in country hospitals decreased overall by 66. In the two major country centres, births
decreased slightly at Mount Gambier, while there was a slight increase in births at Whyalla. Increases occurred at
some hospitals with 100-399 births per year, eg Gawler Health Service, Murray Bridge, Port Lincoln and the Riverland
Regional Hospital at Berri, while decreases were seen at Barossa Health (Tanunda), Naracoorte, Port Augusta and
South Coast (Victor Harbor). Births increased at the smaller country centres of Southern Flinders Health Service
(Crystal Brook) and Peterborough, while numbers of births fell at Ceduna, Mid North Health (Jamestown campus),
Kapunda, Kangaroo Island, Millicent and Quorn.
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
100-399 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 2009page 16
Mothers and Babies
Table 3a: Hospital births by category of hospital, South Australia, 2009
Hospital category Number of births Percent hospital births
Metropolitan teaching 10,680 54.0
Level III (7,630) (38.6)
Other teaching (3,050) (15.4)
Metropolitan private 5,119 25.9
Country 3,967 20.1
Major country (861) (4.4)
100-399 births per annum (2,651) (13.4)
50-99 births per annum (265) (1.3)
<50 births per annum (190) (1.0)
Total 19,766 100.0
Figure 2: Distribution of hospital births by hospital category, South Australia, 2009 (n=19,766)
14.0%
b
0 10 20 30 40 50 60
Country hospitals
Metropolitan private
hospitals
Teaching hospitals
Percentage of hospital births
20.1%
25.9%
54.0%
a Ashford 7.6%
b Burnside 6.6%
c Calvary 4.5%
d Flinders Private 3.3%
e North Eastern Community 3.9%
r Mt Gambier 2.8%
s Gawler 2.0%
t Mount Barker 1.9%
u Port Lincoln 1.6%
v Whyalla 1.6%
w Port Augusta 1.4%
x Other hospitals with 100-399 births per year 6.5%
y Hospitals with 50-99 births per year 1.3%
z Hospitals with <50 births per year 1.0%
W&CH FMC LMHS
e
u
24.6% 15.4%
a c
r s x y zt v w
d
Pregnancy Outcome in South Australia 2009 page 17
Mothers and Babies
Table 3b: Hospital births in South Australia in 2009 by race and hospital
Hospital Caucasian Aboriginal Asian Other Total births
Total number of women
who gave birth
Metropolitan teaching
Women s & Children s Hospital
(W&CH)
3,330 192 914 432 4,868 4,729
Flinders Medical Centre (FMC) 2,449 68 157 88 2,762 2,716
Lyell McEwin Hospital (LMH)** 2,562 109 244 135 3,050 3,017
Total 8,341 369 1,315 655 10,680 10,462
Metropolitan private
Ashford** 1,424 6 56 15 1,501 1,475
Burnside War Memorial (BWMH)** 1,214 1 71 10 1,296 1,276
Calvary** 838 8 42 6 894 890
Flinders Private** 631 1 23 6 661 653
North Eastern Community (NECH)** 745 1 14 7 767 761
Total 4,852 17 206 44 5,119 5,055
Country
Major country
Mt. Gambier** 528 5 8 4 545 537
Whyalla 279 30 3 4 316 315
Subtotal 807 35 11 8 861 852
100-399 births per annum
Barossa Health (Tanunda Centre) 119 0 3 0 122 122
Gawler Health Service*** 385 7 5 3 400 398
Lower North Health Centre (Clare) 106 1 0 0 107 107
Mt. Barker 363 2 9 2 376 376
Murray Bridge Soldiers Memorial 231 17 7 12 267 267
Naracoorte 138 2 6 9 155 155
Pt. Augusta 171 88 5 6 270 269
Pt. Lincoln 287 21 8 2 318 318
Pt. Pirie 170 12 1 4 187 187
Riverland Regional (Berri) 186 17 9 12 224 221
South Coast District (Victor Harbor) 116 2 2 2 122 122
Northern Yorke Peninsula Regional
Health Service (Wallaroo)
97 5 1 0 103 103
Subtotal 2,369 174 56 52 2,651 2,645
** 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 2009page 18
Mothers and Babies
Hospital Caucasian Aboriginal Asian Other Total births
Total women who
gave birth
50-99 births per annum
Loxton 66 1 1 0 68 68
Millicent 82 1 0 1 84 84
Southern Flinders Health Service
(Crystal Brook)
59 2 1 1 63 63
Waikerie 45 1 1 3 50 50
Subtotal 252 5 3 5 265 265
1-49 births per annum
Ceduna 31 11 2 1 45 45
Central Yorke Peninsula (Maitland) 1 1 0 0 2 2
Cowell 2 0 0 0 2 2
Cummins 7 0 0 0 7 7
Ernabella 0 1 0 0 1 1
Kangaroo Island 34 0 0 1 35 35
Kapunda 46 0 1 0 47 47
Meningie 1 0 0 0 1 1
Mid North Health (Jamestown
Campus)
28 0 0 0 28 28
Mid West Health (Streaky Bay) 1 0 0 0 1 1
Mimili 0 1 0 0 1 1
Oodnadatta 0 1 0 0 1 1
Peterborough 10 0 0 0 10 10
Quorn 6 0 0 0 6 6
Southern Yorke Peninsula
(Yorketown)
1 0 0 0 1 1
Strathalbyn 1 0 0 0 1 1
Yalata 0 1 0 0 1 1
Subtotal 169 16 3 2 190 190
Total (country) 3,597 230 73 67 3,967 3,592
Grand total 16,790 616 1,594 766 19,766 19,469
Table 3b continued
Pregnancy Outcome in South Australia 2009 page 19
Mothers and Babies
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 (589 women),
Torres Strait Islander (6 women) and those who are Aboriginal and Torres Strait Islander (12 women). Aboriginal
women accounted for 3.1% of women and gave birth mainly in metropolitan teaching hospitals and country
hospitals. Asian women accounted for 8.1% of women, and gave birth mainly in metropolitan teaching hospitals, but
13.0% gave birth in private hospitals.
Table 4a: Race of women who gave birth, South Australia, 2009
Race Number of women % Women
Caucasian 16,655 85.0
Aboriginal 607 3.1
Asian 1,585 8.1
Other 757 3.8
Total 19,604 100.0
Table 4b: Race and birthplace category of women who gave birth, South Australia, 2009
Birthplace
Race of women
Total Caucasian Aboriginal Asian Other
Number % Number % Number % Number % Number %
Metropolitan
teaching
hospital
8,151 48.9 360 59.3 1,305 82.3 646 85.3 10,462 53.4
Metropolitan
private hospital
4,789 28.8 16 2.6 206 13.0 44 5.8 5,055 25.8
Country
hospital
3,584 21.5 229 37.7 73 4.6 66 8.7 3,952 20.2
Home 130 0.8 2 0.3 1 0.1 1 0.1 134 0.7
Unknown
place of birth
1 0 0 0 0 0 0 0 1 0
Total 16,655 (85.0) 607 (3.1) 1,585 (8.1) 757 (3.8) 19,604 100.0
Pregnancy Outcome in South Australia 2009page 20
Mothers and Babies
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 (30.4%) has exceeded that of the 25-29 years age group
(29.0%) since 2001. Teenage women accounted for 4.1% of women who gave birth and older women aged 35
years or more accounted for 21.1% (Table 4c and Figure 3). Aboriginal women were generally younger than non-
Aboriginal women: 19.6% were teenagers and only 8.1% were 35 years or older. Among Asian women, on the other
hand, only 0.9% were teenagers but 19.7% were 35 years or older.
The age-specific fertility rates have increased in the 25-29 and 40-44 age groups and decreased in the teenage,
20-24, 30-34, 35-39 and 40-44 age groups, when compared with 2008 (Table 4d). The rate was highest in the age
group 30-34 years (120.7 per 1,000 women), followed by the 25-29 years age group (108.5 per 1,000 women). The
general fertility rate (see Appendix 1) was 61.1 per 1,000 women aged 15-44 years, down from 62.0 in 2008. The
total fertility rate (see Appendix 1) was 1.87 live births per woman, down from 1.91 in 2007 and 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, 2009
Age
(years)
Caucasian Aboriginal Asian Other Total
Number % Number % Number % Number % Number %
<15 4 0.0 1 0.2 0 0 0 0 5 0
15-19 638 3.8 118 19.4 14 0.9 36 4.8 806 4.1
20-24 2,467 14.8 212 34.9 164 10.3 165 21.8 3,008 15.3
25-29 4,774 28.7 156 25.7 540 34.1 214 28.3 5,684 29.0
30-34 5,136 30.8 71 11.7 555 35.0 194 25.6 5,956 30.4
35-39 2,986 17.9 42 6.9 255 16.1 122 16.1 3,405 17.4
40-44 605 3.6 7 1.2 54 3.4 24 3.2 690 3.5
45+ 45 0.3 0 0 3 0.2 2 0.3 50 0.3
Total 16,655 (85.0) 607 (3.1) 1,585 (8.1) 757 (3.8) 19,604 100.0
Pregnancy Outcome in South Australia 2009 page 21
Mothers and Babies
Figure 3: Age and race of women who gave birth, 2009 (n=19,604)
0%
20%
40%
60%
80%
100%
Caucasian
n=16,655
Aboriginal
n=607
Asian
n=1,585
Other
n=757
Total n
=19,604
Pe
rc
en
ta
g
e
o
f
w
o
m
en
14-19 20-24 25-29 30-34 35+ Age (years)
Table 4d: Age-specific fertility rates, South Australia, 2009
Age (years) Number of live births
Estimated resident female
population*
Age-specific fertility rate per
1,000 women (ASFR)***
15-19 809** 52,685 15.4**
20-24 3,020 55,493 54.4
25-29 5,731 52,797 108.5
30-34 6,009 49,777 120.7
35-39 3,448 55,935 61.6
40-44 739** 56,455 13.1**
Total 19,756** 323,142 61.1**
* Australian Bureau of Statistics. Population Estimates by Age and Sex, South Australia 2009. 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 = 373.7 per 1,000 women. Total fertility rate = 373.7 x 5 = 1,868.5 live births per 1,000 women
= 1.87 live births per woman.
Pregnancy Outcome in South Australia 2009page 22
Mothers and Babies
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 18.6% of women born outside Australia, the
largest proportion was born in the United Kingdom and Ireland (2.9%). Other countries contributing relatively large
proportions of migrant women were India (1.9% of women ), Vietnam 1.3, China and New Zealand (1.1%), the
Philippines (1.0%), Sudan (0.7%), Afghanistan, Cambodia, Malaysia and South Africa (0.4% each), Poland, South Korea,
Thailand and the United States of America (0.3%), and Canada, Germany, Indonesia, Iraq and Japan, (0.2% each).
Table 5a: Country of birth, major groups,* women who gave birth, South Australia, 2009
Country of birth Number %
1 Oceania and Antarctica 16,205 82.7
2 Europe and the USSR 968 4.9
3 The Middle East and North Africa 311 1.6
4 Southeast Asia 777 4.0
5 Northeast Asia 364 1.9
6 Southern Asia 553 2.8
7 Northern America 94 0.5
8 South America, Central America and the Caribbean 68 0.3
9 Africa (excluding North Africa) 263 1.3
10 Unknown 1 0
Total 19,604 100.0
* 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, 2009
Specified country of birth Number % of women
% of migrant women who gave
birth (n=3,649)
1100 Australia 15,954 81.4 na
2101-2107 The United Kingdom and Ireland 573 2.9 15.7
6104 India 371 1.9 10.2
4110 Vietnam 263 1.3 7.2
5101 China 218 1.1 6
1301 New Zealand 206 1.1 5.6
4107 Philippines 188 1.0 5.1
3207 Sudan 130 0.7 3.6
4105 Malaysia 85 0.4 2.3
9220 South Africa 83 0.4 2.3
6101 Afghanistan 76 0.4 2.1
4102 Cambodia 75 0.4 2.1
4109 Thailand 65 0.3 1.8
2504 Poland 54 0.3 1.5
7104 United States of America 53 0.3 1.4
5105 South Korea 50 0.3 1.4
5103 Japan 49 0.2 1.3
4103 Indonesia 46 0.2 1.3
3104 Iraq 43 0.2 1.2
2305 Germany 41 0.2 1.1
7102 Canada 40 0.2 1.1
All other countries 940 4.8 25.8
Total 19,604 100 100
* ASCCSS, Australian Bureau of Statistics
Pregnancy Outcome in South Australia 2009 page 23
Mothers and Babies
6. Marital status and type of patient
While 88.8% women who gave birth in 2009 were married or in a de facto relationship, 11.2% were single (10.0%
were never married and 1.2% were widowed, separated or divorced, Table 6a). Of never married women, over a fifth
were teenagers and nearly 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 (92.2% v 65.2%, Table 6b). Nearly a third
of all women were private patients (31.8%).
Table 6a: Marital status and age, women who gave birth, South Australia, 2009
Age (years)
Marital status of women
TotalNever married Married/de facto
Widowed/
separated/divorced
Number % Number % Number % Number %
<20 420 21.4 384 2.2 7 2.9 811 4.1
20-24 628 32.0 2346 13.5 34 13.9 3,008 15.3
25-29 435 22.2 5190 29.8 59 24.2 5,684 29.0
30-34 300 15.3 5588 32.1 68 27.9 5,956 30.4
35-39 145 7.4 3201 18.4 59 24.2 3,405 17.4
40-44 30 1.5 646 3.7 14 5.7 690 3.5
45+ 3 0.2 44 0.3 3 1.2 50 0.3
Total 1,961 (10.0) 17,399 (88.8) 244 (1.2) 19,604 100.0
Table 6b: Type of patient and marital status, women who gave birth, South Australia, 2009
Type of
patient
Marital status of women
TotalNever married Married/de facto
Widowed/
separated/divorced
Number % Number % Number % Number %
Hospital/public 1,807 92.1 11,342 65.2 225 92.2 13,374 68.2
Private 154 6.3 6,057 34.8 19 7.8 6,230 31.8
Total 1,961 (10.0) 17,399 (88.8) 244 (1.2) 19,604 100.0
Pregnancy Outcome in South Australia 2009page 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 (24.4 v 0.4%) 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 9.7% of fathers and 4.1% of mothers.
Table 7: Occupation* of father and mother, women who gave birth, South Australia, 2009
Occupation
Father Mother
Number % Number %
1 Managers and administrators 3,265 16.7 1,533 7.8
2 Professionals 2,880 14.7 2,909 14.8
3 Para professionals 968 4.9 1,203 6.1
4 Tradespersons 3,552 18.1 683 3.5
5 Clerks 554 2.8 2,427 12.4
6 Salespersons and personal service workers 1,108 5.7 2,955 15.1
7 Plant and machine operators and drivers 1,236 6.3 85 0.4
8 Labourers and related workers 2,459 12.5 573 2.9
9 Students 443 2.3 758 3.9
Pensioners 107 0.5 34 0.2
Home duties 83 0.4 4,785 24.4
Unemployed 774 3.9 691 3.5
Other 264 1.3 162 0.8
Unknown 1,911 9.7 806 4.1
Total 19,604 100.0 19,604 100.0
* Australian Bureau of Statistics. ASCO. First Edition. Occupation Definitions. Canberra: ABS,1990. (Catalogue No. 1223.0).
Pregnancy Outcome in South Australia 2009 page 25
Mothers and Babies
8. Previous pregnancy outcomes
Forty-two percent of women had no previous birth and 30.1% were pregnant for the first time. Among Aboriginal
women and those of other races, these proportions were lower, with 35.1% and 34.5% respectively giving birth for
the first time. The proportion of women giving birth for the first time was the highest among Asian women (52.2%).
The proportion of women of parity 4 or greater was much higher among Aboriginal women (12.9%) and women of
other races (13.5%), than among Caucasian women (2.9%) and Asian women (1.6%) (Table 8a).
Table 8a: Parity by race, women who gave birth, South Australia, 2009
Parity
Race of women
TotalCaucasian Aboriginal Asian Other
Number % Number % Number % Number % Number %
0-primigravida 4,937 29.6 145 23.9 619 39.1 191 25.2 5,892 30.1
0-multigravida 1,902 11.4 68 11.2 208 13.1 70 9.2 2,248 11.5
1 5,959 35.8 156 25.7 524 33.1 213 28.1 6,852 35.0
2 2,587 15.5 109 18.0 156 9.8 111 14.7 2,963 15.1
3 781 4.7 51 8.4 52 3.3 70 9.2 954 4.9
4 281 1.7 42 6.9 18 1.1 49 6.5 390 2.0
?5 208 1.2 36 5.9 8 0.5 53 7.0 305 1.6
Total 16,655 (85.0) 607 (3.1) 1,585 (8.1) 757 (3.8) 19,604 100.0
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, 2009
(multigravidae only, n= 13,712)
Previous pregnancy outcome Number %
Miscarriage 4,680 34.1
Termination of pregnancy 2,802 20.4
Stillbirth 224 1.6
Neonatal death 93 0.7
Ectopic pregnancy 313 2.3
Of the 11,464 women who had previously given birth, 3,471 (30.3%) had had a previous caesarean section.
Pregnancy Outcome in South Australia 2009page 26
Mothers and Babies
9a. Gestation at first antenatal visit
In 2009 gestation at the first antenatal visit was reported as unknown for 10.8% of women (Table 9a). If the
unknowns are excluded, among the remaining women, 78.1% attended within the first 14 weeks. This proportion
was much lower for Aboriginal women (51.0%) than for non-Aboriginal women (78.9%).
Table 9a: Gestation at first antenatal visit, women who gave birth, by race, South Australia, 2009 (n=19,604)
Gestation
at first
antenatal
visit
Race of women
TotalNon-Aboriginal Aboriginal
Number %
Adjusted %
(excluding
unknown )
(n=16,951) Number %
Adjusted %
(excluding
unknown )
(n=545) Number %
Adjusted %
(excluding
unknown )
(n=17,496)
<14 weeks
gestation
13,381 70.4 78.9 278 45.8 51.0 13,659 69.7 78.1
14 weeks or
greater*
3,570 18.8 21.1 267 44.0 49.0 3,837 19.6 21.9
Unknown 2,046 10.8 - 62 10.2 - 2,108 10.8 -
Total 18,997 (96.9) 100.0 607 (3.1) 100.0 19,604 (100.0) 100.0
* includes 34 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 16,305 women (83.2% of women who gave birth), height and weight were not
reported for 2,995 women (18.4%), so that BMI could only be calculated for 13,310 women who gave birth in 2009
(67.9%). Table 9b shows that of these women, 6,724 (50.5%) were overweight (BMI >=25.0), with 3,080 (23.1%)
obese (BMI >=30.0) and 1,347 (10.1%) were severely or morbidly obese (BMI >=35.0).
It is hoped that with interest in this area and wider use of the South Australian Pregnancy Record, reporting of
gestation at first antenatal visit and height and weight will improve.
Table 9b: BMI of women who gave birth, South Australia, 2009
BMI
(based on height and weight at first antenatal visit where gestation
at first antenatal visit was <20 weeks) Number %
Adjusted %
(excluding unknown )
(n=13,310)
<18.5 (underweight) 420 2.6 3.2
18.5 24.9 (normal) 6,166 37.8 46.3
25.0 29.9 (overweight) 3,644 22.3 27.4
30.0 34.9 (obese) 1,733 10.6 13.0
35.0 39.9 (severely obese) 811 5.0 6.1
40 or more (morbidly obese) 536 3.3 4.0
Unknown 2,995 18.4 -
Total 16,305 100.0 100.0
Pregnancy Outcome in South Australia 2009 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 6.3% of women (9.6% of Aboriginal women), the number of antenatal visits
attended was not known. If women for whom the number of antenatal visits was unknown are excluded, 32.6% of
Aboriginal women compared with 6.9% of Caucasian women were reported to have made less than 7 visits. Among
Asian women this proportion was 11.1%. 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 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, 2009
Antenatal visits
Race of women
TotalCaucasian Aboriginal Asian Other
Number % Number % Number % Number % Number %
None 20 0.1 12 2.0 1 0.1 1 0.1 34 0.2
1-6 1,065 6.4 167 27.5 162 10.2 105 13.9 1,499 7.6
?7 14,573 87.5 370 61.0 1,304 82.3 596 78.7 16,843 85.9
Unknown 997 6.0 58 9.6 118 7.4 55 7.3 1,228 6.3
Total 16,655 (85.0) 607 (3.1) 1,585 (8.1) 757 (3.9) 19,604 100.0
9d. Type of antenatal care
Table 9d shows that the main types of antenatal care used were hospital clinics (44.6%), obstetricians in private
practice (32.2%), general practitioners (17.1%) and birth centres (7.7%). There were 34 women (0.2%) who had no
antenatal care at all. Individual women may have used more than one type of antenatal care.
Table 9d: Type of antenatal care, women who gave birth, South Australia, 2009 (n = 19,604)
Type of care Number %
No antenatal care 34 0.2
Hospital clinic 8,745 44.6
Obstetrician in private practice 6,311 32.2
General practitioner (GP) 3,361 17.1
Birth centre 1,506 7.7
GP/midwife (shared care) 1,287 6.6
Midwifery Group Practice (W&CH) 923 4.7
Obstetrician/midwife (shared care) in private practice 392 2.0
Home birth midwife 131 0.7
Northern Women s Community Health Centre (NWCHC) 111 0.6
Other 52 0.3
Not stated 32 0.2
Pregnancy Outcome in South Australia 2009page 28
Mothers and Babies
10. Smoking
Table 10a shows that 15.9% of all women were reported to be smokers at their first antenatal visit, and 3.7% had
quit smoking before their first visit. Smoking status was unknown for 1.7% of women. The proportion of all women
smoking during pregnancy has been declining in the state, from 25% in 1998 to 15.9% in 2008 and 2009.
The proportion of Aboriginal women who reported that they smoked at the first antenatal visit (52.2%) was
the lowest recorded over the past decade, with the highest rate (61.2%) reported in 2005. However, this was
considerably higher than non-Aboriginal women (14.7%). Additionally, 4.4% of Aboriginal women reported that
they quit smoking in pregnancy prior to their first antenatal visit, compared with 3.7% of non-Aboriginal women.
Among age groups, the highest rates of smoking were among teenagers (32.9%) and women aged 20-24 years
(29.1%). Smoking rates were high among all age groups of Aboriginal women varying from 47.9% among teenage
women to 56.1% among those aged 20-24 years.
In the second half of pregnancy (Table 10b), 13.8% of women (2,715 women) were reported to be smokers and
0.5% (106 women) smoked more than 20 cigarettes per day, but the number of cigarettes smoked was not known
for 2.5% of women. In the second half of pregnancy, 46.8% of Aboriginal women smoked, compared with 12.8%
of non-Aboriginal women. A higher proportion of Aboriginal women (3.0% compared with 0.5%) also smoked more
than 20 cigarettes per day, but the number of cigarettes smoked was not known for 5.4% of Aboriginal women and
2.4% of non-Aboriginal women.
Table 10a: Tobacco smoking status at first antenatal visit, non-Aboriginal and Aboriginal women who gave
birth, South Australia, 2009
Smoking status
Non-Aboriginal Aboriginal Total
Number % Number % Number %
Smoker 2,797 14.7 317 52.2 3,114 15.9
Quit before 1st visit 695 3.7 27 4.4 722 3.7
Non-smoker 15,192 80.0 251 41.4 15,443 78.8
Unknown smoking status 313 1.6 12 2.0 325 1.7
Total 18,997 (96.9) 607 (3.1) 19,604 100.0
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, 2009
Average number of tobacco
cigarettes smoked per day
Non-Aboriginal Aboriginal Total
Number % Number % Number %
None 16,115 84.8 290 47.8 16,405 83.7
Occasional (<1) 42 0.2 5 0.8 47 0.2
1-10 1,686 8.9 186 30.6 1,872 9.5
11-20 615 3.2 75 12.4 690 3.5
21-30 80 0.4 14 2.3 94 0.5
31-40 6 0.0 2 0.3 8 0.0
41+ 2 0.0 2 0.3 4 0.0
Unknown 451 2.4 33 5.4 484 2.5
Total 18,997 (96.9) 607 (3.1) 19,604 100.0
Pregnancy Outcome in South Australia 2009 page 29
Mothers and Babies
11. Medical conditions
Medical conditions were recorded in the current pregnancy for 6,683 women (34.1%). The frequencies of specified
medical conditions are provided in Table 11.
Table 11: Medical conditions in current pregnancy, women who gave birth, South Australia, 2009
Medical condition Number % of women (n = 19,604)
1 None 12,921 65.9
2 Anaemia 1,334 6.8
3 Urinary tract infection 520 2.7
4 Hypertension (pre-existing) 216 1.1
5 Diabetes (pre-existing) 126 0.6
6 Epilepsy 109 0.6
7 Asthma 1,210 6.2
8 Other 4,430 22.6
12. Obstetric complications
Obstetric complications were recorded for 6,665 women who gave birth (34.0%). The reported frequencies of the
more common complications are presented in Table 12.
There was one direct, one indirect, and one incidental maternal death as well as two late direct deaths and two late
incidental deaths (see definition in Appendix 1) notified to the Maternal, Perinatal and Infant Mortality Committee in 2009.3
Table 12: Frequency of some obstetric complications, women who gave birth, South Australia, 2009
Obstetric complication Number % of women (n= 19,604)
No complication 12,939 66.0
Threatened miscarriage 379 1.9
Antepartum haemorrhage (APH) - Abruption 108 0.6
APH - Placenta praevia 118 0.6
APH Other & unknown causes 466 2.4
Pregnancy hypertension 1,395 7.1
Intrauterine growth restriction (suspected) 757 3.9
Gestational diabetes 1,083 5.5
Other complications (including 4 women with impaired glucose tolerance) 3,823 19.5
Pregnancy Outcome in South Australia 2009page 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
98.1% of women, amniocentesis for 3.4% and chorion villus sampling for 0.7%.
For a proportion of women, it was not known whether a specific procedure had been performed, eg 1.9% 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, 2009
Procedure
Yes No Unknown
Number % Number % Number %
MSAFP (Neural tube defect screen etc) 5,558 28.4 13,671 69.7 375 1.9
Triple/Quadruple screen (Down syndrome etc) 11,951 61.0 7,332 37.4 321 1.6
Ultrasound 19,226 98.1 272 1.4 106 0.5
Chorion villus sampling 145 0.7 19,221 98.0 238 1.2
Amniocentesis 665 3.4 18,699 95.4 240 1.2
Cordocentesis 9 0.0 19,351 98.7 244 1.2
Other surgical procedure 86 0.4 19,518 99.6 0 0
14a. Onset of labour
Labour occurred spontaneously in 52.7% of women who gave birth (Table 14a). It was induced in 29.4%, and the
methods of induction used were artificial rupture of membranes (ARM) in 66.9% of inductions, prostaglandins in
60.7% and oxytocics in 49.8% (Table 14b). More than one method was used in many cases.
Table 14a: Onset of labour, women who gave birth, South Australia, 2009
Onset of labour Number %
Spontaneous 10,327 52.7
No labour caesarean section 3,507 17.9
Induction 5,770 29.4
Total 19,604 100.0
Table 14b: Method of induction of labour, women who gave birth, South Australia, 2009
Method of induction Number
% of women
(n =19,604)
% of inductions
(n =5,770)
No induction 13,834 70.6 -
ARM 3,861 19.7 66.9
Oxytocics 2,873 14.7 49.8
Prostaglandins 3,503 17.9 60.7
Pregnancy Outcome in South Australia 2009 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 20.3% of women were induced for prolonged pregnancy (41 or more completed weeks),
13.7% for hypertension, 7.7% for diabetes (including gestational diabetes and glucose intolerance), 6.2% for
intrauterine growth restriction (IUGR) and 3.7% for premature rupture of membranes (PROM). Other defined reasons
accounted for smaller proportions. Other than defined reasons accounted for 53.2%.
Figure 4: Reasons for induction of labour, SA, 2009 (n=5,770)
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
The proportion of women giving birth who had labour augmented was 21.9%. Of the 10,327 women who went into
spontaneous labour, augmentation was used for 4,286 (41.5%). Methods used in augmentation were artificial rupture
of membranes (ARM) (74.6%), oxytocics (40.1%) 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, 2009
Method of augmentation Number % of women (n=19,604) % of augmentations (n=4,286)
Any augmentation 4,286 21.9 100.0
1 ARM 3,198 16.3 74.6
2 Oxytocics 1,720 8.8 40.1
3 Prostaglandins 31 0.2 0.7
Pregnancy Outcome in South Australia 2009page 32
Mothers and Babies
15a. Presentation and method of birth
Of the women who gave birth, 55.4% had normal spontaneous vaginal births (Table 15a and Figure 5A). Caesarean
section was performed for 32.4% of women, with 15.7% of women having elective sections; forceps were utilised
for 4.6%, ventouse for 7.2% and breech birth for the remaining 0.4%. 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 4.7% of births and caesarean section was the method of birth for 89.6% of breech
presentations. Caesarean section was utilised for 90.5% of breech presentations in singletons (Table 15c).
Table 15a: Method of birth, women who gave birth, South Australia, 2009
Method of birth Number %
Normal spontaneous vaginal 10,854 55.4
Forceps 902 4.6
Assisted breech (no forceps) 18 0.1
Caesarean section (elective) 3,084 15.7
Caesarean section (emergency) 3,273 16.7
Ventouse 1,416 7.2
Breech extraction 1 0.0
Breech spontaneous 53 0.3
Assisted breech (with forceps for head) 3 0.0
Total 19,604 100.0
Figure 5a:Method of birth, women who gave birth, South Australia, 2009 (n = 19,604)
Ventouse (7.2%)
Caesarean section
(32.4%)
Forceps (4.6%)
Breech delivery (0.4%)
Normal
spontaneous
vaginal (55.4%)
Pregnancy Outcome in South Australia 2009 page 33
Mothers and Babies
Table 15b: Method of birth by presentation, all births, South Australian 2009 (n=19,901)
Method of birth
Presentation
TotalVertex Breech Other Unknown
Number % Number % Number % Number % Number %
1 Normal
spontaneous
10,855 58.0 0 0 38 19.1 10 29.4 10,903 54.8
2 Forceps 895 4.8 0 0 13 6.5 0 0 908 4.6
3 Assisted
breech (no
forceps)
0 0 30 3.2 1 0.5 0 0 31 0.2
4 Elective
caesarean
2,630 14.0 483 51.3 47 23.6 9 26.5 3,169 15.9
5 Emergency
caesarean
2,930 15.6 360 38.3 90 45.2 13 38.2 3,393 17.0
6 Ventouse 1,417 7.6 0 0 9 4.5 0 0 1,426 7.2
7 Breech
extraction
0 0 10 1.1 1 0.5 0 0 11 0.1
8 Breech
spontaneous
0 0 55 5.8 0 0 2 5.9 57 0.3
9 Assisted
breech
(forceps)
0 0 3 0.3 0 0 0 0 3 0.0
Total 18,727 (94.1) 941 (4.7) 199 (1.0) 34 (0.2) 19,901 100.0
Table 15c: Method of birth in breech presentation, by plurality, all births, South Australia, 2009 (n = 941)
Plurality
Assisted*
breech
Elective
caesarean
Emergency
caesarean
Breech
extraction
Breech
spontaneous
Total
Singleton 21* 413 284 1 51 770
Twins 12_ 67 74 9 4 166
Triplets 0_ 3 2 0 0 5
Total 33 (3.5%) 483 (51.3%) 360 (38.3%) 10 (1.1%) 55 (5.8%) 941 (100.0%)
* in three of the assisted breech births forceps were applied to the head.
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 (38.7%),
failure to progress/cephalopelvic disproportion (CPD) (26.8%), fetal distress (15.5%) and malpresentation (11.5%).
The main reasons for elective sections were previous caesarean section (67.6%), malpresentation (13.3%) and
multiple pregnancy (2.5%), and the main reasons given for emergency sections were failure to progress or CPD
(49.9%), fetal distress (30.1%), previous caesarean section (11.5%) and malpresentation (9.7%).
Pregnancy Outcome in South Australia 2009page 34
Mothers and Babies
Figure 5b: Reason for caesarean section, 2009 (n=6,357)
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
Figure 5c: Reason for elective caesarean section, 2009 (n=3,084)
0 10 20 30 40 50 60 70
Other
IUGR
Multiple pregnancy
APH
Pregnancy hypertension/hypertension
Malpresentation
Fetal distress
Previous caesarean
CPD
Percentage
Figure 5d: Reason for emergency caesarean section, 2009 (n=3,273)
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 2009 page 35
Mothers and Babies
16. Complications of labour and birth and perineal status after birth
Complications of labour or birth were recorded for 7,196 women who gave birth (36.7%). The reported frequency
of some complications is presented in Table 16. Among all 19,604 women who gave birth, episiotomy was performed
for 2,245 (11.5%). Among the 13,247 women who gave birth vaginally, 3,726 (28.1%) had an intact perineum after
birth, 5,704 (43.1%) had a repair of a perineal tear, of whom 422 (3.2%) had a third or a fourth degree tear; 16.9%
had an episiotomy.
Table 16: Frequency of some complications of labour and birth, women who gave birth, South Australia, 2009
Complication of labour Number of women % of women (n=19,604)
None 12,408 63.3
Post-partum haemorrhage (PPH) primary (amount not specified) 65 0.3
PPH - 600-999ml 1,299 6.6
PPH 1,000 ml or more 707 3.6
Fetal distress 2,334 11.9
Retained placenta 286 1.5
Prolonged labour 178 0.9
Cord prolapse 22 0.1
Wound infection 23 0.1
Third degree tear (391) or fourth degree tear (31) 422 2.2
Failure to progress 2,532 12.9
Other 4,609 23.5
17. Fetal monitoring during labour
Cardiotocography (CTG) was performed during labour for 62.3% of women who gave birth. The majority of these
(50.5% of women) were external CTGs (Table 17a) while a scalp clip was used for 11.8%.
A fetal scalp pH was taken during labour in 181 women who gave birth (0.9%, Table 17b).
Table 17a: CTG performed during labour, women who gave birth, South Australia, 2009
CTG during labour Number of women % of women (n=19,604)
1 None 7,403 37.8
2 External 9,893 50.5
3 Scalp clip 2,308 11.8
Table 17b: Fetal scalp pH taken during labour, women who gave birth, South Australia, 2009
Fetal scalp pH taken Number of women % of women (n=19,604)
1 No 19,423 99.1
2 Yes 181 0.9
Pregnancy Outcome in South Australia 2009page 36
Mothers and Babies
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 31.4% and
for anaesthesia for birth for 26.6% of women. The proportion of women who had an epidural for either was 32.5%
(6,362 women). The proportion of women who had a spinal anaesthetic increased between 1991 and 2009 from
0.2% to 0.9% for analgesia and from 0.5% to 23.6% for anaesthesia. General anaesthesia was used for 2.1% of
births. It was used in 6.2% 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, 2009
Analgesia Number % of women
1 None 7,106 36.2
2 Nitrous oxide and oxygen 7,573 38.6
3 Narcotic (parenteral) 3,742 19.1
4 Epidural (lumbar/caudal) 6,148 31.4
5 Spinal 174 0.9
6 Other 281 1.4
7 Combined spinal-epidural 9 0.0
* more than one method may be used for each woman
Table 18b: Anaesthesia for birth,* women who gave birth, South Australia, 2009
Anaesthesia Number % of women
1 None 6,984 35.6
2 Local anaesthesia 2,527 12.9
3 Pudendal 181 0.9
4 Epidural (lumbar/caudal) 5,209 26.6
5 Spinal 4,635 23.6
6 General anaesthesia 402 2.1
7 Other 166 0.8
8 Combined spinal-epidural 62 0.3
* more than one method may be used for each woman
Pregnancy Outcome in South Australia 2009 page 37
Mothers and Babies
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 five 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, 2009
Postnatal length of stay (days)
Public Private Total
Number % Number % Number %
<1 640 4.8 24 0.4 664 3.4
1 2,282 17.1 84 1.4 2,366 12.2
2 3,299 24.7 240 3.9 3,539 18.2
3 3,042 22.8 743 12.1 3,785 19.4
4 2,282 17.1 2,431 39.6 4,713 24.2
5 1,120 8.4 1,850 30.1 2,970 15.3
6 359 2.7 554 9.0 913 4.7
7 or more 309 2.3 210 3.4 519 2.7
Total 13,333 100.0 6,136 100.0 19,469 100.0
Table 19b: Average postnatal length of stay by type of patient & type of birth, women who gave birth in
South Australian hospitals, 2009
Average length of stay
Public Private Total
Vaginal
(n=9,435)
Caesarean
(n=3,898)
Total
(n=13,333)
Vaginal
(n=3,677)
Caesarean
(n=2,459)
Total
(n=6,136)
Vaginal
(n=13,112)
Caesarean
(n=6,357)
Total
(n=19,469)
Mean number of days 2.29 4.13 2.83 3.88 5.13 4.38 2.74 4.52 3.32
( SD) ( 1.80) ( 1.71) ( 1.96) ( 1.85) ( 1.17) ( 1.72) ( 1.95) ( 1.60) ( 2.02)
Median number of days 2 4 3 4 5 4 3 5 3
Pregnancy Outcome in South Australia 2009page 38
Mothers and Babies
20. Sex of baby
The sex distribution of babies is provided in Table 20; the male:female sex ratio was 1.08:1.
Table 20: Sex of baby, all births, South Australia, 2009
Sex of baby Number %
Male 10,338 51.9
Female 9,563 48.1
Total 19,901 100.0
21. Birthweight and gestation
The birthweight distribution of all births is presented in Table 21. The percentage of low birthweight babies (<2,500g)
was 7.3%, and that of very low birthweight babies (<1,500g) was 1.6%. The mean birthweight was 3,328g (SD
622.6g), with birthweights ranging from 55g to 5,930g. The proportion of low birthweight babies was 13.6%
among babies of Aboriginal women compared with 7.1% among babies of non-Aboriginal women. Among live born
babies, these proportions were 12.8% and 6.6% respectively.
Table 21: Birthweight distribution of all births, South Australia, 2009
Birthweight (g) Number of births Percentage of births
<400 64 0.3
400-499 22 0.1
500-749 37 0.2
750-999 54 0.3
1,000-1,499 144 0.7
1,500-1,999 299 1.5
2,000-2,499 838 4.2
2,500-2,999 3,157 15.9
3,000-3,499 7,192 36.1
3,500-3,999 5,987 30.1
4,000-4,499 1,814 9.1
4,500+ 292 1.5
Unknown 1 0.0
Total 19,901 100.0
In 2009, 1,458 babies (7.3%) were of low birthweight and 1,785 (9.0%) were preterm (<37 weeks gestation). The
proportion of preterm births was 15.5% among babies of Aboriginal women compared with 8.8% among babies of
non-Aboriginal women.
Pregnancy Outcome in South Australia 2009 page 39
Mothers and Babies
22. Birth injuries
Birth injuries were reported in 128 live births (0.6%). The most common injury reported was cephalhaematoma.
Fracture and nerve injury occurred less frequently (Table 22).
Table 22: Birth injuries* in 19,761 live births, South Australia, 2009
Birth injury Number of live births % of live births
None 19,633 99.4
Fracture 13 0.1
Dislocation 1 0.0
Nerve Injury 20 0.1
Cephalhaematoma 67 0.3
Other 32 0.2
*more than one injury may occur in each birth
23. Treatment given in neonatal period
The proportions of live births who received specified treatments in the neonatal period are provided in Table 23, which
shows that 84.8% of neonates did not receive any of these treatments.
Table 23: Neonatal treatment given, all live births, South Australia, 2009
Neonatal treatment Number % of live births
None of the treatments listed below 16,764 84.8
Oxygen therapy for more than 4 hours 968 4.9
Phototherapy for jaundice 1,364 6.9
Gavage feeding more than once 1,626 8.2
Any intravenous therapy 1,853 9.4
Pregnancy Outcome in South Australia 2009page 40
Mothers and Babies
24. Level of care utilised
Table 24 shows that 84.5% of neonates utilised Level I care only. Level II care was used by 15.3% of neonates, Level
III care at the Women s and Children s Hospital or Flinders Medical Centre by 2.9% and paediatric intensive care at
the Women s and Children s Hospital by 0.3% of neonates. As would be expected, with decreasing birthweight, an
increasing percentage of babies required Level II and Level III care.
Table 24: Level of nursery care utilised by birthweight, all live births, South Australia, 2009
Level of care utilised
Birthweight (g)
<1,500
(n=223)
1,500-2,499
(n=1,117)
2,500+
(n=18,421)
Total
(n=19,761)
Number % Number % Number % Number %
Level I only 18 8.1 198 17.7 16,474 89.4 16,690 84.5
Level II 192 86.1 909 81.4 1,928 10.5 3,029 15.3
Level III (W&CH & FMC) 187 83.9 219 19.6 167 0.9 573 2.9
Level III (W&CH Paediatric intensive care) 4 1.8 14 1.3 32 0.2 50 0.3
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 5.1 days (SD 9.64) and
the median duration 4 days. The mean duration was 3.5 days (SD 3.14) for term births and 22.3 days (SD 25.80) 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, 2009
Length of stay (days)
Preterm births Term births Total
Number % Number % Number %
<1 24 1.4 590 3.3 614 3.1
1 17 1.0 2,189 12.2 2,206 11.2
2 39 2.3 3,274 18.2 3,313 16.9
3 63 3.8 3,501 19.5 3,564 18.2
4 105 6.3 4,318 24.0 4,423 22.5
5 119 7.1 2,676 14.9 2,795 4.2
6 86 5.2 783 4.4 869 4.4
7-13 337 20.2 493 2.7 830 4.2
14-20 279 16.7 76 0.4 355 1.8
21-27 197 11.8 27 0.2 224 1.1
28 or more 400 24.0 35 0.2 435 2.2
Total 1,666 100.0 17,962 100.0 19,628 100.0
Pregnancy Outcome in South Australia 2009 page 41
Mothers and Babies
26. Congenital anomalies
Among the 19,901 births in 2009 there were 539 births (2.7%) notified with congenital anomalies, compared with
an average of 2.5% over the past decade.; 510 (2.6%) of these births had anomalies 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 1999-2009.
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
In 2009 the number of spina bifida cases reported at birth increased considerably from 4 cases in 2008 to 18 in 2009.
No reason for this recent sudden increase can be determined, but these cases will remain under review. 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, 1999-2009, South Australia
Congenital abnormality Year
BPA* CODE 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Number of births = 18,519 17,871 17,704 17,745 17,844 17,522 18,196 18,803 19,757 19,970 19,901
74000-74029 Anencephalus 2 3 1 4 0 1 0 1 1 1 3
74100-74199 Spina bifida 4 5 9 4 7 5 5 8 5 4 18
74200-74209 Encephalocele 1 0 0 1 0 0 1 1 2 1 0
74230-74239 Hydrocephalus 7 4 4 3 7 6 9 10 12 11 14
74900-74909 Cleft palate 8 10 14 17 9 10 15 11 12 9 11
74910-74929 Cleft lip and palate (Total cleft lip) 17 16 15 16 14 17 9 16 30 28 25
75030-75038 Tracheo-oesophageal fistula,
oesophageal atresia and stenosis
6 2 10 3 2 2 5 4 12 5 6
75120-75124 Atresia and stenosis of large
intestine, rectum and anal canal
5 9 3 9 6 6 12 4 7 9 7
75260-75261 Hypospadias and epispadias 43 40 40 42 34 41 38 29 41 40 39
75300-75301 Renal agenesis and dysgenesis 4 5 7 5 10 4 12 8 8 3 11
75520-75549 Limb reduction defects 9 11 6 7 5 8 8 13 18 9 8
75660-75669 Anomalies of diaphragm 4 7 6 7 4 4 7 12 7 9 9
75670-75679 Anomalies of abdominal wall 8 8 13 10 13 12 9 10 7 9 17
75800-75809 Down syndrome 25 19 21 19 13 14 19 17 17 21 22
* British Paediatric Association Classification of Diseases. London: The British Paediatric Association, 1979.
Pregnancy Outcome in South Australia 2009page 42
Mothers and Babies
27. Multiple births
Among women who gave birth there were 289 twin and 4 triplet pregnancies compared with 19,311 singleton ones.
Thus there was one twin pregnancy in every 68 pregnancies and one triplet pregnancy in every 4,901 pregnancies
among women who gave birth. Women who gave birth with twins or triplets comprised 1.5% of all women who
gave birth. The total number of multiple births was 590 (3.0% of total births).
A comparison of multiple births with singleton ones shows that multiple births were of lower birthweight (with
59.8% being of low birthweight compared with 5.7% for singletons, Table 27a), and gestation (with 67.5% being
preterm births compared with 7.2% for singletons, Table 27b). The proportion of live births in hospital at 28 days was
20.3% for multiple births compared with 1.7% for singletons, and the perinatal death rate for multiple births was
also elevated (28.8 compared with 8.9 deaths per 1,000 births for singletons, Table 27c).
Table 27a: Birthweight by plurality, all births, South Australia, 2009
Birthweight (g)
Singleton births Multiple births
Number % Number %
<400 56 0.3 8 1.4
400-499 20 0.1 2 0.3
500-749 29 0.2 8 1.4
750-999 41 0.2 13 2.2
1,000-1,499 114 0.6 30 5.1
1,500-1,999 198 1.0 101 17.1
2,000-2,499 647 3.4 191 32.4
2,500-2,999 2,988 15.5 169 28.6
3,000-3,499 7,138 37.0 54 9.2
3,500-3,999 5,973 30.9 14 2.4
4,000-4,499 1,814 9.4 0 0
4,500+ 292 1.5 0 0
Unknown 1 0.0 0 0.0
Total 19,311 100.0 590 100.0
Table 27b: Gestation at birth by plurality all births, South Australia, 2009
Gestation (weeks)
Singleton births Multiple births Total
Number % Number % Number %
<24 87 0.5 10 1.7 97 0.5
24-27 63 0.3 14 2.4 77 0.4
28-31 140 0.7 47 8.0 187 0.9
32-36 1,097 5.7 327 55.4 1,424 7.2
37-41 17,845 92.4 192 32.5 18,037 90.6
42+ 79 0.4 0 0 79 0.4
Total 19,311 100.0 590 100.0 19,901 100.0
Pregnancy Outcome in South Australia 2009 page 43
Mothers and Babies
Table 27c: Perinatal outcome by plurality, all births, South Australia, 2009
Perinatal outcome
Singleton births Multiple births Total
Number % Number % Number %
Stillbirth 131 0.7 9 1.5 140 0.7
Discharged within 28 days 18,812 97.4 453 76.8 19,265 96.8
In hospital at 28 days 327 1.7 120 20.3 447 2.2
Neonatal death 41 0.2 8 1.4 49 0.2
Total 19,311 100.0 590 100.0 19,901 100.0
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 2009 was 9.5 per 1,000 births. The stillbirth rate was
7.0 per 1,000 births and the neonatal mortality rate was 2.5 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 (953.5 per 1,000). The
lowest perinatal mortality rate of 1.1 per 1,000 births was observed for births weighing 3,000-3,499g, with heavier
birthweights showing increasing perinatal mortality rates: the perinatal mortality rate for the birthweight group
3,500 3,999g was 1.5 per 1,000 births, and for 4,000-4,499g birthweight group 2.2 per 1,000 births. The perinatal
mortality rate for babies of normal birthweight (2,500g or more) was 1.7 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, 2009
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 64 12 52 812.5 10 833.3 62 968.8
400-499 22 5 17 772.7 3 600.0 20 909.1
500-749 37 24 13 351.4 7 291.7 20 540.5
750-999 54 48 6 111.1 2 41.7 8 148.1
1,000-1,499 144 134 10 69.4 6 44.8 16 111.1
1,500-1,999 299 290 9 30.1 6 20.7 15 50.2
2,000-2,499 838 827 11 13.1 4 4.8 15 17.9
2,500-2,999 3,157 3,151 6 1.9 5 1.6 11 3.5
3,000-3,499 7,192 7,185 7 1.0 1 0.1 8 1.1
3,500-3,999 5,987 5,983 4 0.7 5 0.8 9 1.5
4,000-4,499 1,814 1,810 4 2.2 0 0 4 2.2
4,500+ 292 292 0 0 0 0 0 0
Unknown 1 0 1* na 0 0 1* na
Total 19,901 19,761 140 7.0 49 2.5 189 9.5
* this stillbirth at 20 weeks gestation was not weighed at parents request.
na: not applicable
Pregnancy Outcome in South Australia 2009page 44
Mothers and Babies
Figure 6: Perinatal mortality rate by birthweight, all births, South Australia, 2009
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)
Table 28b: Perinatal mortality by gestational age at birth, South Australia, 2009
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 97 22 75 773.2 16 727.3 91 938.1
24-27 77 65 12 155.8 8 123.1 20 259.7
28-31 187 174 13 69.5 5 28.7 18 96.3
32-36 1,424 1,410 14 9.8 13 9.2 27 19.0
37-41 18,037 18,012 25 1.4 7 0.4 32 1.8
42+ 79 78 1 12.7 0 0 1 12.7
TOTAL 19,901 19,761 140 7.0 49 2.5 189 9.5
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 3.5
per 1,000 births in 2009, with a stillbirth rate of 2.6 per 1,000 births and an early neonatal mortality rate of 0.9 per
1,000 live births. The perinatal mortality rate for births to Aboriginal women was the second lowest on record in
the State at 14.6 per 1,000 births in 2009 compared with 9.3 per 1,000 births for births to non-Aboriginal women
(Table 28d). This was considerably lower than the previous year s rate of 23.5 per 1000 births for Aboriginal women
in 2008, however, due to the small numbers involved, the perinatal mortality rate for Aboriginal births may fluctuate
considerably from year to year.
Pregnancy Outcome in South Australia 2009 page 45
Mothers and Babies
Table 28c: Perinatal mortality, South Australia, 2009 (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* 19,901 19,761 140 7.0 49 2.5 189 9.5
?500g/22 weeks 19,814 19,744 70 3.5 36 1.8 106 5.3
(WHO National
Statistics)
27** 1.4 97** 4.9
?1,000g/28 weeks 19,723 19,672 51 2.6 27 1.4 78 4.0
(WHO International
Statistics)
18** 0.9 69** 3.5
* includes live births of any gestation. There were 64 births of birthweight <400g
** only neonatal deaths within the first 7 days of life are included
Table 28d: Perinatal mortality by race, all births, South Australia, 2009
Race
Total births Stillbirths Neonatal deaths Alive at 28 days Perinatal deaths
Number Number Number Number Number
Deaths
per 1,000
births
Caucasian 16,921 105 41 16,775 146 8.6
Aboriginal 618 8 1 609 9 14.6
Asian 1,595 18 5 1,572 23 14.4
Other 767 9 2 756 11 14.3
Total 19,901 140 49 19,712 189 9.5
29. Home births
Supplementary Birth Records were received from home birth midwives for 125 planned home births which occurred
at home in 2009. There were nine unplanned home births in South Australia in 2009 which have been excluded from
the planned home birth statistics. Six of these were to women who received antenatal care with the Midwifery Group
Practice at the Women s and Children s Hospital or the Northern Women s Community Health Centre. The other three
unplanned home births were to women who had no antenatal care. Ascertainment of planned home births occurring
at home in South Australia for the year 2009 is estimated to be 94.5% (121 out of 128 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, 35 women who planned to birth at home were transferred to hospital
care before birth. Statistics for all 160 planned home births in 2009 are provided in Tables 29-32, by place of birth.
Pregnancy Outcome in South Australia 2009page 46
Mothers and Babies
Table 29: Planned home births by age of women, South Australia, 2009
Age (years)
Birthed at home Birthed in hospital Total
Number % Number % Number %
<20 2 1.6 1 2.9 3 1.9
20-24 5 4.0 5 14.3 10 6.3
25-29 33 26.4 7 20.0 40 25.0
30-34 40 32.0 14 40.0 54 33.8
35-39 38 30.4 7 20.0 45 28.1
40-44 7 5.6 1 2.9 8 5.0
45+years 0 0 0 0 0 0
Total 125 100.0 35 100.0 160 100.0
Table 30: Method of birth in planned home births, South Australia, 2009
Method of birth
Birthed at home Birthed in hospital Total
Number % Number % Number %
Normal spontaneous vaginal 122 97.6 20 57.1 142 88.8
Forceps 0 0 3 8.6 3 1.9
Emergency caesarean section 0 0 10 28.6 10 6.3
Breech spontaneous 3 2.4 2 5.7 5 3.1
Total 125 100.0 35 100.0 160 100.0
Table 31: Birthweight distribution of planned home births, South Australia, 2009
Birthweight (g)
Birthed at home Birthed in hospital Total
Number % Number % Number %
1,500-1,999 0 0 1 2.9 1 0.6
2,000-2,499 2 1.6 0 0 2 1.3
2,500-2,999 2 1.6 3 8.6 5 3.1
3,000-3,499 41 32.8 8 22.9 49 30.6
3,500-3,999 49 39.2 11 31.4 60 37.5
4,000-4,499 25 20.0 9 25.7 34 21.3
4,500+ 6 4.8 2 5.7 8 5.0
Unknown 0 0 1 2.9 1 0.6
Total 125 100.0 35 100.0 160 100.0
Table 32: Perinatal outcome in planned home births, South Australia, 2009
Perinatal outcome
Birthed at home Birthed in hospital Total
Number % Number % Number %
Stillbirth 1 0.8 2 5.7 3 1.9
Discharged within 28 days 122 97.6 33 94.3 155 96.9
Neonatal death 2 1.6 0 0 2 1.3
Total 125 100.0 35 100.0 160 100.0
Pregnancy Outcome in South Australia 2009 page 47
Mothers and Babies
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 2,305 women for whom it was reported that birthing
unit was their intended place of birth. Of these women, 1,166 gave birth in the birthing units while 1,139 women
(49.4%) 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, 24.7% had caesarean
sections and 17.8% had instrumental births. These statistics have also been included in the statistics for the respective
hospitals. Sixty-nine babies (3.0%) were of low birthweight and there were twelve perinatal deaths (perinatal
mortality rate 5.2 per 1,000 births).
Table 33: Planned birthing unit births by age of women, South Australia, 2009
Age (years)
Birthed in birthing unit Birthed in labour ward Total
Number % Number % Number %
<20 74 6.3 49 4.3 123 5.3
20-24 269 23.1 199 17.5 468 20.3
25-29 376 32.2 354 31.1 730 31.7
30-34 291 25.0 350 30.7 641 27.8
35-39 139 11.9 157 13.8 296 12.8
40-44 15 1.3 29 2.5 44 1.9
45+ 2 0.2 1 0.1 3 0.1
Total 1166 100.0 1,139 100.0 2,305 100.0
Table 34: Method of birth in planned birthing unit births, South Australia, 2009
Method of birth
Birthed in birthing unit Birthed in labour ward Total
Number % Number % Number %
Normal spontaneous vaginal 1,136 97.4 651 57.2 1,787 77.5
Forceps 6 0.5 100 8.8 106 4.6
Assisted breech (no forceps) 0 0 2 0.2 2 0.1
Caesarean section (elective) 0 0 34 3.0 34 1.5
Caesarean section (emergency) 0 0 247 21.7 247 10.7
Ventouse 24 2.1 102 9.0 126 5.5
Breech spontaneous 0 0.0 2 0.2 2 0.1
Assisted breech (with forceps for head) 0 0.0 1 0.1 1 0.0
Total 1,166 100.0 1,139 100.0 2,305 100.0
Pregnancy Outcome in South Australia 2009page 48
Mothers and Babies
Table 35: Birthweight distribution of planned birthing unit births, South Australia, 2009
Birthweight (g)
Birthed in birthing unit Birthed in labour ward Total
Number % Number % Number %
<1,500 0 0 12 1.0 12 0.5
1,500-1,999 1 0.1 9 0.8 10 0.4
2,000-2,499 9 0.8 38 3.3 47 2.0
2,500-2,999 130 11.1 134 11.7 264 11.4
3,000-3,499 429 36.8 383 33.5 812 35.2
3,500-3,999 437 37.5 428 37.4 865 37.4
4,000-4,499 139 11.9 123 10.8 262 11.3
4,500+ 21 1.8 17 1.5 38 1.6
Total 1,166 100.0 1,144 100.0 2,310 100.0
Table 36: Perinatal outcome in planned birthing unit births, South Australia, 2009
Perinatal outcome
Birthed in birthing unit Birthed in labour ward Total
Number % Number % Number %
Stillbirth 1 0.1 9 0.8 10 0.4
Discharged within 28 days 1,164 99.8 1,123 98.2 2,287 99.0
Prolonged hospitalisation (in hospital
at 28 days)
1 0.1 10 0.9 11 0.5
Neonatal death 0 0 2 0.2 2 0.1
Total 1,166 100.0 1,144 100.0 2,310 100.0
Pregnancy Outcome in South Australia 2009 page 49
Mothers and Babies
III. Terminations of Pregnancy
1. Numbers and rates
There were 5,054 terminations of pregnancy notified in South Australia in 2009. This was 47 less than in 2008. The
abortion rate was 15.6 abortions per 1,000 women aged 15-44 years. Specific abortion legislation was introduced
in 1970, following which the abortion rate rose to a peak of 13.9 in 1980, followed by a period of relative stability
in the 1980s. Another increase in the abortion rate commenced in 1991 (Table 37 and Fig 7) and reached a peak of
17.9 in 1999. The rate declined significantly from 17.7 in 2001 to 15.3 in 2005 and was stable for three years before
increasing to 16.0 in 2008.
Table 37: Abortion rate per 1,000 women aged 15-44 years, South Australia, 1970-2009
Year Number of abortions Abortions per 1,000 women aged 15-44 years
1970 1,440 6.0
1971 2,409 9.6
1972 2,692 10.6
1973 2,847 11.1
1974 2,867 10.9
1975 3,000 11.1
1976 3,289 11.9
1977 3,494 12.4
1978 3,895 13.6
1979 3,880 13.3
1980 4,081 13.9
1981 4,096 13.7
1982 4,061 13.4
1983 4,036 13.1
1984 4,091 13.1
1985 4,079 12.9
1986 4,327 13.5
1987 4,229 13.1
1988 4,263 13.0
1989 4,342 13.2
1990 4,463 13.4
1991 4,696 14.1
1992 4,717 14.2
1993 4,959 15.0
1994 5,140 15.7
1995 5,475 16.9
1996 5,545 17.2
1997 5,609 17.5
1998 5,488 17.2
1999 5,679 17.9
2000 5,580 17.6
2001 5,579 17.7
2002 5,467 17.5
2003 5,216 16.7
2004 4,931 15.9
2005 4,715 15.3
2006 4,889 15.5
2007 4,884 15.4
2008 5,101 16.0
2009 5,054 15.6
Pregnancy Outcome in South Australia 2009page 50
Termination of Pregnancy
Figure 7: Abortion rate in South Australia, 1970-2009
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
Abortions per 1,000 women aged 15-44 years
Year
2. Age of women
The age distribution of women who had terminations is shown in Table 38. Among the five- year age groups (Table
39), the highest abortion rate was among women aged 20-24 years (27.0 per 1,000 women) followed by women
aged 25-29 years (20.9) and teenage women 15-19 years (17.0 per 1,000 women). Compared with 2008, abortion
rates have fallen for teenage women (18.5 per 1,000 women in 2008) and women aged 20-24 years. The abortion
proportion (abortions as a proportion of abortions and live births) was 0.20; it was highest among teenagers (0.53),
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 (0.76 for those aged <15 years).
Table 38: Terminations of pregnancy by age, South Australia, 2009
Age (years) Number %
12 1 0.0
13 2 0.0
14 13 0.3
15 51 1.0
16 142 2.8
17 161 3.2
18 240 4.8
19 302 6.0
20-24 1,498 29.6
25-29 1,105 21.9
30-34 726 14.4
35-39 588 11.6
40-44 213 4.2
45+ 12 0.2
Total 5,054 100.0
Pregnancy Outcome in South Australia 2009 page 51
Termination of Pregnancy
The distribution of abortions and live births by age in South Australia in 2008 (Table 39 and Figure 8A) demonstrates
that the largest proportion of abortions occurred in the age group 20-24 years while the largest proportion of live
births occurred among those 30-34 years, who had the highest fertility (live birth) rate of 120.7 per 1,000 women.
Teenagers accounted for 18.1% of the abortions and 4.1% of the live births in South Australia in 2009. 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 abortion rate (Figure 8B). The teenage pregnancy rate in 2009 was 32.7 per 1,000 women,
and is the lowest rate recorded since 1970.
Table 39: Abortion and live birth rates and abortion proportions by age, South Australia, 2009
Age
(years)
Number of
abortions
Estimated resident
female population
June 30 2008*
Abortion
rate per
1,000
women
Number
of live
births**
Fertility rate
per 1,000
women
Abortions
+ live
births
Abortion
proportion
<15 16 na na 5 na 21 0.76
15-19 896 52,685 17.3** 804 15.4** 1,700 0.53
20-24 1,498 55,493 27.0 3,020 54.4 4,518 0.33
25-29 1,105 52,797 20.9 5,731 108.5 6,836 0.16
30-34 726 49,777 14.6 6,009 120.7 6,735 0.11
35-39 588 55,935 10.5 3,448 61.6 4,036 0.15
40-44 213 56,455 4.0** 689 13.1** 902 0.24
45+ 12 na na 50 na 62 0.19
Total 5,054 323,142 15.6** 19,756 61.1** 24,810 0.20
*Australian Bureau of Statistics. Population Estimates by Age and Sex, South Australia 2009. Canberra: ABS, 2010 (Catalogue No 3235.0).
**Terminations of pregnancy are excluded from the numbers of live births. The abortion and live birth rates for women aged 15-19 years include
terminations and live births at younger ages, and the rates for women aged 40-44 years include terminations and live births at older ages, while the
total rates include all terminations and live births.
Figure 8a: Abortions and live births by age, South Australia, 2009
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=5,054 n=19,756 n=24,810
Pregnancy Outcome in South Australia 2009page 52
Termination of Pregnancy
Figure 8b: Teenage pregnancy, abortion and birth rates, South Australia, 1970-2009
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
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
3. Place of residence and place where termination performed
While 81.8% of terminations were performed for metropolitan residents (Table 40), a larger proportion (95.0%)
was performed in metropolitan hospitals (Table 41), which include the Pregnancy Advisory Centre at which 2,854
terminations (56.0% in the state) were performed.
Table 40: Terminations by place of residence, South Australia, 2009
Residence of women Number %
Metropolitan 4,135 81.8
Country 919 18.2
Total 5,054 100.0
Table 41: Terminations by hospital category, South Australia, 2009
Hospital where termination performed Number %
Metropolitan public 4,709 93.2
Metropolitan private 94 1.9
Country 251 5.0
Total 5,054 100.0
The proportion of terminations performed by obstetricians was 19.1%, and the proportion performed by medical
practitioners in family advisory clinics was 77.8% in 2009 (Table 42).
Table 42: Terminations by category of doctor, South Australia, 2009
Category of doctor performing termination Number %
Obstetrician/gynaecologist 966 19.1
Trainee obstetrician/gynaecologist 78 1.5
Medical practitioner in family advisory clinic 3,932 77.8
General practitioner 78 1.5
Total 5,054 100.0
Pregnancy Outcome in South Australia 2009 page 53
Termination of Pregnancy
4. The reason for termination
The number of terminations performed for fetal reasons was 172 (3.4% of terminations), of which 165 (95.9%) were
for specified fetal or chromosomal abnormalities (Table 43).
Table 43: Reason for termination for fetal reasons, South Australia, 2009
Reason for termination Number %
Identified chromosomal abnormality 83 48.3
Other identified fetal abnormality 82 47.7
Possibility of damage from drugs 7 4.1
Possibility of hereditary disease 0 0.0
Total 172 100.0
5. Gestation, method and complications
The majority of terminations (92.0%) were performed within the first 14 weeks of pregnancy and most frequently (in
82.3% of cases) by vacuum aspiration. There were 90 terminations performed at 20 weeks gestation or later: 54.4%
of these were performed for fetal reasons.
Twenty-five women were reported to have had complications (0.5%). The types of complications are listed in Table 44.
Complications are known to be under-notified as the notification forms are usually completed about the time the woman
is discharged from hospital after the procedure. The South Australian Abortion Reporting Committee reported that 42
other women who had terminations in 2009 had complications after discharge, which had not been notified. This was
ascertained through linkage of the abortion data with the South Australian hospital morbidity collection (ISAAC).
Table 44: Complications of terminations, South Australia, 2009
Complications Number % of complications
Haemorrhage - intra-operative 1 4.0
- post-operative 5 20.0
Perforation of or trauma to body of uterus 1 4.0
Cervical tear 3 12.0
Retained products of conception 13 52.0
Other 2 8.0
Total 25 100.0
Pregnancy Outcome in South Australia 2009page 54
Termination of Pregnancy
6. Previous terminations. Total abortion rate and Total first abortion rate
Of the 5,054 women who had terminations, 1,689 (33.4%) had had a previous termination (Table 45a). Among the
teenagers 14.4% had had a previous termination; 29.6% of women aged 20-24 years and 45.4% of women aged
35-39 years had undergone a previous termination. The total abortion rate (TAR) for 2009 was 471.5 per 1,000
women aged 15-44 years (Table 45b). This represents the number of abortions 1,000 women would have during their
lifetime if they experienced the abortion rates of the different age groups for 2009. As a woman may have more than
one abortion in her lifetime, to estimate how prevalent abortion is at these age-specific abortion rates for 2009, a
total first abortion rate (TFAR, Table 45c) may be calculated after exclusion of women with repeat terminations. This
TFAR for 2009 was 313.5 per 1,000 women aged 15-44 years. This suggests that 31.3% of women would have an
abortion in their lifetime if they experienced the abortion rates of the different age groups for 2009.
Table 45a: Women with previous terminations by age, South Australia, 2009
Age (years) Number % % of age group
< 15 0 0.0 0.0
15 - 19 131 2.6 14.6
20 - 24 443 8.8 29.6
25 - 29 459 9.1 41.5
30 - 34 303 6.0 41.7
35 - 39 267 5.3 45.4
40+ 86 1.7 38.2
Total 1,689 100.0 33.4
Further details of abortions in South Australia in 2009 may be obtained from the Seventh Annual Report of the South
Australian Abortion Reporting Committee for the year 2009.6
Pregnancy Outcome in South Australia 2009 page 55
Termination of Pregnancy
Table 45b: Calculation of total abortion rate (TAR) for 2009 for South Australia*
Age
(years)
Number of women
who had terminations
Estimated female resident
population 30th June 2008
Abortion rate
per 1,000 women
15-19* 912* 52,685 17.3*
20-24 1,498 55,493 27.0
25-29 1,105 52,797 20.9
30-34 726 49,777 14.6
35-39 588 55,935 10.5
40-44* 225* 56,455 4.0*
Total 5,054 323,142 15.6
*In these calculations, abortions for women under 15 years are included in the age group 15-19 yrs and abortions for women aged 45 years or more
are included in the age group 40-44 years, as is traditional.
Total abortion rate = sum of abortion rates for 5-year age groups x 5 = 94.3 x 5 = 471.5 per 1,000 women aged 15-44 years.
Table 45c: Calculation of total first abortion rate (TFAR) for 2009 for South Australia*
Age
(years)
Number of women
who had
terminations (A)
Number of women
who had previous
terminations (B)
Number of women
who had first
termination (A)
(B)
Estimated
female resident
population
June 30th 2008
First abortion
rate per 1,000
women
15-19 912* 131* 781* 52,685 14.8*
20-24 1,498 443 1055 55,493 19.0
25-29 1,105 459 646 52,797 12.2
30-34 726 303 423 49,777 8.5
35-39 588 267 321 55,935 5.7
40-44 225* 86* 139* 56,455 2.5*
Total 5,054 1,689 3,365 323,142 10.4
* In these calculations, abortions for women under 15 years are included in the age group 15-19 yrs and abortions for women aged 45 years or more
are included in the age group 40-44 years, as is traditional.
Total first abortion rate (TFAR) = sum of first abortion rates for 5-year age groups x 5 = 62.7 x 5 = 313.5 per 1,000 women aged 15-44 yrs.
Pregnancy Outcome in South Australia 2009page 56
Termination of Pregnancy
IV. OBSTETRIC PROFILES BY HOSPITAL CATEGORY
Obstetric profiles for five hospital categories for 2009 are provided in Table 46 and Figures 9-28.
These hospital categories are:
1. Metropolitan teaching Level III hospitals with neonatal intensive care facilities, ie the Women s & Children s
Hospital and Flinders Medical Centre,
2. Other metropolitan teaching hospitals, ie the Lyell McEwin Health Service and Modbury Hospital,
3. Metropolitan private hospitals,
4. The two major country hospitals (Mount Gambier and Whyalla) and
5. Other country hospitals (mainly smaller).
A list of maternal and baby factors identified either as risk factors for poor perinatal outcome in earlier analyses,7 or
of general interest, is provided with means for all state hospital births as well as proportions for the five 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
x100
Total number of women who gave birth in state hospitals
Number of Aboriginal women who gave birth in state hospitals
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
16. Naracoorte Health Service Inc
Pregnancy Outcome in South Australia 2009 page 57
Obstetric Profiles by Hospital Category
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 five different categories of hospitals. These have been provided
since 1986 to hospitals with 100 or more births per year, together with their individual hospital profiles, including
crude and standardized perinatal mortality ratios,8 the latter with exclusion of perinatal deaths from congenital
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 2009page 58
Obstetric Profiles by Hospital Category
Table 46: Obstetric profiles by hospital category, South Australia, 2009: 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
Level III
teaching
Other
teaching
Private Major Other
Maternal factors
Women (n=19,469) 811+ 122 2,716 7,445 3,017 5,055 852 3,100
% Aboriginal women 3.1 0.1 8.4 3.4 3.6 0.3 4.1 6.3
% Antenatal visits <7* 8.3 0.3 13.8 13.8 10.6 0.6 7.8 6.2
% Teenage women 4.2 0.1 8.2 4.4 8.2 0.2 6.1 5.5
% Women ?35 years 21.0 12.3 32.9 19.9 13.3 31.9 12.7 15.7
% Single women 11.3 2.1 18.5 16.6 13.1 2.1 11.6 11.6
% 4+ prior live births 3.3 0.5 8.6 3.6 5.7 0.6 3.6 4.4
% 1+ prior perinatal deaths 1.6 0.3 2.2 2.0 1.7 1.0 2.3 1.2
% Obstetric complications 34.2 18.0 38.8 42.9 36.9 26.2 29.5 24.8
% Labour complications 36.9 23.4 45.8 46.8 39.7 27.9 27.0 27.7
% Induction 29.6 23.1 34.6 29.9 27.4 32.1 28.9 27.3
% Emergency caesarean 16.8 10.8 20.1 17.7 17.4 16.9 13.7 14.7
% Elective caesarean 15.8 10.9 23.5 12.6 13.0 23.5 16.7 13.7
% Total caesarean 32.7 22.4 41.3 30.3 30.4 40.4 30.4 28.5
% Ultrasound examination* 98.8 97.0 99.4 99.0 98.6 99.0 98.2 98.1
% Amniocentesis* 3.4 0.8 5.1 4.3 2.3 4.1 2.2 1.8
% Episiotomy 11.5 4.5 16.2 10.8 12.2 15.3 9.2 7.1
% Repair of perineal tear 29.3 19.0 38.3 30.6 21.5 34.3 23.6 27.2
% Epidural analgesia 31.6 8.2 41.3 32.9 23.7 44.2 27.5 16.7
% Spinal analgesia 0.9 0.2 2.6 0.3 1.3 1.1 0.6 1.6
% Private patients 31.5 2.5 100.0 7.1 2.4 100.0 15.5 11.2
% Primiparous women 41.6 34.7 45.1 43.2 39.0 44.8 36.5 36.5
% Previous caesarean 17.7 13.1 22.7 16.1 16.4 22.4 16.3 15.7
% PPH 10.6 3.2 11.9 15.8 12.5 5.0 7.3 6.5
Baby factors
Births (n=19,766) 824+ 122 2,762 7,630 3,050 5,119 861 3,106
% Birthweight <2,500g 7.4 1.1 7.8 12.3 6.7 3.7 4.5 2.8
% Gestational age <37 weeks
at birth
9.0 0.4 9.3 14.5 9.2 5.4 5.0 2.2
% Prolonged hospitalisation
(>27 days)
2.3 0 1.6 5.1 0.8 0.4 0.9 0.4
% Neonatal intensive care
(Level III or W&CH paediatric
intensive care)
3.0 0.3 1.9 6.4 1.5 0.6 1.4 0.8
% Birth defect 2.7 0.5 2.8 4.2 3.1 1.2 2.3 1.2
* adjusted for missing values
+ mean number of women who gave birth, or mean number of births for the 24 hospitals or groups of hospitals
Pregnancy Outcome in South Australia 2009 page 59
Obstetric Profiles by Hospital Category
Figure 9: Percentage of Aboriginal women by hospital category
0
2
4
6
8
10
1 2 3 4 5
Hospital category
Pe
rc
en
ta
g
e
90th percentile
Mean
10th percentile
Figure 10: Percentage of women with <7 antenatal visits by hospital category
0
2
4
6
8
10
12
14
16
1 2 3 4 5
Hospital category
Pe
rc
en
ta
g
e
90th percentile
Mean
10th percentile
Figure 11: Percentage of teenage women by hospital category
0
1
2
3
4
5
6
7
8
9
1 2 3 4 5
Hospital category
Pe
rc
en
ta
g
e
90th percentile
Mean
10th percentile
Pregnancy Outcome in South Australia 2009page 60
Obstetric Profiles by Hospital Category
Figure 12: Percentage of women 35 years or more by hospital category
0
5
10
15
20
25
30
35
1 2 3 4 5
Hospital category
Pe
rc
en
ta
g
e
90th percentile
Mean
10th percentile
Figure 13: Percentage of single women by hospital category
0
2
4
6
8
10
12
14
16
18
20
1 2 3 4 5
Hospital category
Pe
rc
en
ta
g
e
90th percentile
Mean
10th percentile
Figure 14: Percentage of women with 4 or more prior livebirths by hospital category
0
2
4
6
8
10
1 2 3 4 5
Hospital category
Pe
rc
en
ta
g
e
90th percentile
Mean
10th percentile
Pregnancy Outcome in South Australia 2009 page 61
Obstetric Profiles by Hospital Category
Figure 15: Percentage of women with 1 or more prior perinatal deaths by hospital category
0
0.5
1
1.5
2
2.5
1 2 3 4 5
Hospital category
Pe
rc
en
ta
g
e
90th percentile
Mean
10th percentile
Figure 16: Percentage of women with obstetric complications by hospital category
0
10
20
30
40
50
1 2 3 4 5
Hospital category
Pe
rc
en
ta
g
e
10th percentile
90th percentile
Mean
Figure 17: Percentage of women with complications during labour or birth by hospital category
0
10
20
30
40
50
60
1 2 3 4 5
Hospital category
Pe
rc
en
ta
g
e
90th percentile
Mean
10th percentile
Pregnancy Outcome in South Australia 2009page 62
Obstetric Profiles by Hospital Category
Figure 18: Percentage of women with induction of labour by hospital category
0
5
10
15
20
25
30
35
40
45
1 2 3 4 5
Hospital category
Pe
rc
en
ta
g
e
90th percentile
Mean
10th percentile
Figure 19: Percentage of women having epidural analgesia by hospital category
0
10
20
30
40
50
1 2 3 4 5
Hospital category
Pe
rc
en
ta
g
e
90th percentile
Mean
10th percentile
Figure 20: Percentage of breech births by hospital category
0
0.2
0.4
0.6
0.8
1
1.2
1 2 3 4 5
Hospital category
Pe
rc
en
ta
g
e
90th percentile
Mean
10th percentile
Pregnancy Outcome in South Australia 2009 page 63
Obstetric Profiles by Hospital Category
Figure 21: Percentage of emergency caesarean sections by hospital category
0
5
10
15
20
25
1 2 3 4 5
Hospital category
Pe
rc
en
ta
g
e
90th percentile
Mean
10th percentile
Figure 22: Percentage of elective caesarean sections by hospital category
0
5
10
15
20
25
1 2 3 4 5
Hospital category
Pe
rc
en
ta
g
e
90th percentile
Mean
10th percentile
Figure 23: Percentage of total caesarean sections by hospital category
0
5
10
15
20
25
30
35
40
45
1 2 3 4 5
Hospital category
Pe
rc
en
ta
g
e
90th percentile
Mean
10th percentile
Pregnancy Outcome in South Australia 2009page 64
Obstetric Profiles by Hospital Category
Figure 24: Percentage of births with birthweight below 2,500g by hospital category
0
2
4
6
8
10
12
14
1 2 3 4 5
Hospital category
Pe
rc
en
ta
g
e 90th percentile
Mean
10th percentile
Figure 25: Percentage of births with gestation less than 37 weeks by hospital category
0
2
4
6
8
10
12
14
16
1 2 3 4 5
Hospital category
Pe
rc
en
ta
g
e
90th percentile
Mean
10th percentile
Figure 26: Percentage of births with prolonged hospitalisation by hospital category
0
1
2
3
4
5
6
1 2 3 4 5
Hospital category
Pe
rc
en
ta
g
e
10th percentile
90th percentile
Mean
Pregnancy Outcome in South Australia 2009 page 65
Obstetric Profiles by Hospital Category
Figure 27: Percentage of live births requiring neonatal intensive care by hospital category
0
1
2
3
4
5
6
7
1 2 3 4 5
Hospital category
Pe
rc
en
ta
g
e
90th percentile
10th percentile
Mean
Figure 28: Percentage of births with birth defects by hospital category
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
1 2 3 4 5
Hospital category
Pe
rc
en
ta
g
e
10th percentile
90th percentile
Mean
Pregnancy Outcome in South Australia 2009page 66
Obstetric Profiles by Hospital Category
V. Clinical and Maternity Performance Indicators
1. Clinical indicators
These clinical indicators of The Australian Council on Healthcare Standards ( ACHS Obstetrics Indicators - Clinical
Indicator Users Manual Version 5 for use in 2007 ) are reported for the state in pages 55-58. They are also reported
for hospital categories and individual hospitals in the Pregnancy and Neonatal Care Bulletin 2009.
Indicator 1: Induction of labour other than for defined indications
Rationale: These indicators have been included because induction of labour is a common obstetric
intervention and one which is often stated by community critics to be unnecessarily high.
Clinical indicator 1.1: Induction of labour other than for defined indications among all inductions
Numerator: The number of women undergoing induction of labour for indications other than those
defined (n=2,919). These defined indications are diabetes, premature rupture of membranes,
hypertensive disorders (including chronic renal disease), intrauterine growth restriction,
isoimmunisation, fetal distress (as documented by the clinician), fetal demise, chorioamnionitis,
prolonged pregnancy (41 completed weeks or more), twins and antepartum haemorrhage.
Patients having augmentation of labour are excluded in both numerator and denominator data.
Denominator: The total number of women undergoing induction of labour for any reason (excluding
augmentation of labour) (n = 5,770).
Clinical indicator 1.1 =
5,770
2,919 x 100
= 50.6% (95%CI 49.3%-51.9%).
Clinical indicator 1.2: Induction of labour other than for defined indications among all women who
gave birth
Numerator: The number of women undergoing induction of labour for indications other than those listed
above (excluding augmentation of labour) (n=2,919).
Denominator: The total number of women who gave birth (including augmentation of labour) (n=19,604).
Clinical indicator 1.2 =
19,604
2,919 x 100
= 14.9% (95%CI 14.4%-15.4%).
Indicator 2: Rate of vaginal birth following primary caesarean section
Rationale: This indicator has been included to monitor the conduct of labour and trial of scar in those
women who have had a previous primary (first) caesarean section
Clinical indicator 2.1: Rate of vaginal birth following primary caesarean section
Numerator: The number of women who gave birth vaginally following a previous primary (first) caesarean
section and having no intervening pregnancies greater than 20 weeks gestation (n=427).
Denominator: The total number of women who gave birth who have had a previous primary (first) caesarean
section and no intervening pregnancies greater than twenty weeks gestation (n=2,450).
Clinical indicator 2.1 =
2,450
427 x 100
= 17.4% (95%CI 15.9%-19.0%).
Pregnancy Outcome in South Australia 2009 page 67
Clinical and Maternity Performance Indicators
Indicator 3: Primary caesarean section for failure to progress
Rationale: This indicator is to monitor the adequacy of trial of labour. There are two indicators, one for
failure to progress after a period of labour with cervical dilatation of 3cm or less and the other
with cervical dilatation of more than 3cm. As information on cervical dilatation is not collected,
the two indicators have been combined.
Clinical indicator 3.0: Primary caesarean section for failure to progress among primary non-elective
caesarean sections
Numerator: The number of women undergoing primary (first) caesarean section for failure to progress
(clinician s documented statement), which may include CPD, uterine inertia, persistent occipito-
posterior position (n=1,443).
Denominator: The total number of women undergoing primary non-elective caesarean section (n=2,589).
Clinical indicator 3.0 =
2,589
1,443 x 100
= 55.7% (95%CI 53.8%-57.7%).
Indicator 4: Primary caesarean section for fetal distress
Rationale: To determine the comparative frequency of caesarean section for fetal distress.
Clinical indicator 4.1: Primary caesarean section for fetal distress among all women who gave birth
Numerator: The number of women undergoing primary caesarean section for fetal distress in labour as
evidenced by the clinician s documented diagnosis of fetal distress (n=890).
Denominator: The total number of women who gave birth including those with a vaginal birth (n=19,604).
Clinical indicator 4.1 =
19,604
890 x 100 = 4.5% (95% CI 4.3%-4.8%).
Clinical indicator 4.2: Primary caesarean section for fetal distress among primary caesarean sections
Numerator: The number of women undergoing primary caesarean section for fetal distress as defined above
(n=890).
Denominator: The total number of women who gave birth by primary caesarean section only (n = 3,507).
Clinical indicator 4.2 =
3,507
890 x 100 = 25.4% (95%CI 23.9%-26.9%).
Indicator 5: Incidence of an intact lower genital tract in primiparous patients birthing vaginally
Rationale: This indicator has been included because a high incidence of an intact perineum is considered a
desirable outcome.
Clinical indicator 5.1: Incidence of an intact lower genital tract in primiparous women who gave
birth vaginally
Numerator: The number of primiparous patients not requiring surgical repair or suture of the lower genital
tract (those structures below and not including the cervix) following birth (n=1,379).
Denominator: The total number of primiparous women who gave birth vaginally (n=5,483).
Clinical indicator 5.1 =
5,483
1,379 x 100
= 25.1% (95%CI 24.0%-26.3%).
Pregnancy Outcome in South Australia 2009page 68
Clinical and Maternity Performance Indicators
Indicator 6: Apgar score
Rationale: This indicator has been included as a measure of the outcome of labour, with particular emphasis
on the assessment of baby well-being.
Clinical indicator 6.1: Apgar score of 4 or below at five minutes after birth among all babies except
antepartum fetal deaths
Numerator: The number of babies born with an Apgar score of 4 or below at five minutes post birth (n=80).
Denominator: The total number of babies born (excluding fetal deaths in utero diagnosed prior to
commencement of labour) (n=19,833).
Clinical indicator 6.1 = = 0.4%
80 x 100
19,833
(95%CI 0.3%-0.5%).
Indicator 7: Term babies transferred or admitted to a neonatal intensive care unit for reasons other
than congenital abnormality
Rationale: This indicator has been included as an index of the overall management of labour in terms of
outcome.
Clinical indicator 7.1: Term babies transferred or admitted to a neonatal intensive care unit for reasons
other than congenital abnormality
Numerator: The number of term babies (37 weeks gestation or later) transferred/admitted to a neonatal
intensive care unit for reasons other than congenital abnormality (n=95).
Denominator: The total number of term live babies born (n=18,090).
Clinical indicator 7.1 =
18,090
95 x 100 = 0.5% (95%CI 0.4%-0.6%).
Pregnancy Outcome in South Australia 2009 page 69
Clinical and Maternity Performance Indicators
2. Maternity performance indicators, hospitals with at least 500 births per year
The first two of these indicators are from the original Victorian set of maternity performance indicators, while three
others are ACHS clinical indicators. These six indicators are as follows:
1. Induction of labour proportion for selected primiparae
= Number of selected primiparae undergoing induction of labour
Number of selected primiparae who gave birth
2. Caesarean section rate for selected primiparae
= Number of selected primiparae undergoing caesarean section
Number of selected primiparae who gave birth
The selected primipara is aged >=20 and <=34 years, with a singleton pregnancy, delivered at gestation >=37 and
<=41 weeks, with an infant not small for gestational age (classified using birthweight percentiles rather than clinical
suspicion of light for dates). The birthweight percentiles used are the national birthweight-gestation percentiles.9
These specifications are slightly different from those of the selected primipara of the Core Maternity Indicators
Project10 and will be modified to those specifications in later reports.
3. VBAC: proportion of women who gave birth vaginally following a previous primary (first) caesarean
section and no intervening births.
This is as defined for Clinical indicator 2 (page 56) and was 17.4% for the state in 2009 (and 17.1% for state
hospitals) in 2009.
4. PRIMIP no repair: proportion of women not requiring surgical repair following vaginal birth.
This is as defined for Clinical indicator 5 (page 57) and was 25.1% for the state in 2009 (24.7% for state hospitals).
5. TERM NICU: proportion of term babies admitted to neonatal intensive care (NICU) for reasons other than
congenital abnormality.
This is as defined for Clinical indicator 7 (page 58) and was 0.5% for the state (as well as for state hospitals) for 2009.
6. SPMR: Standardized perinatal mortality ratio for all births.
This is as defined8 in the Pregnancy and Neonatal Care Bulletin 2009. 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.
Expected number of deaths
Observed number of deaths
SPMR = x 100
To obtain the expected number of deaths for a hospital, the state hospital perinatal mortality rate for 2009 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
Pregnancy Outcome in South Australia 2009page 70
Clinical and Maternity Performance Indicators
Statistics for the six maternity performance indicators for 2009 are provided in Figures 29a 29g for the nine
hospitals, A I, with at least 500 births in 2009. SPMRs for the preceding five years combined, 2005-2009, 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 2009 or for the last five-year period
2005-2009 (Fig 29G) was statistically significant.
Figure 29a: Induction of labour proportion for selected primiparae, SA hospitals with >=500 births per year, 2009
0
10
20
30
40
50
A B C D E F G H I
Hospital
%
Induction of labour %
*SA hospitals = 36.5%
Figure 29b: Caesarean section rate for selected primiparae, SA hospitals with >=500 births per year, 2009
0
10
20
30
40
50
60
A B C D E F G H I
Hospital
%
Caesarean section %
*SA hospitals = 30.8%
Pregnancy Outcome in South Australia 2009 page 71
Clinical and Maternity Performance Indicators
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, 2009
0
10
20
30
40
A B C D E F G H I
Hospital
%
VBAC %
*SA hospitals = 17.1%
Figure 29d: PRIMIP no repair: proportion of primiparous women not requiring surgical repair following
vaginal birth, SA hospitals with >=500 births per year, 2009
0
10
20
30
40
A B C D E F G H I
Hospital
%
Primip no repair %
*SA Hospitals = 24.7%
Figure 29e: TERM NICU: proportion of term babies admitted to NICU for reasons other than congenital
abnormality, SA hospitals with >=500 births per year, 2009
0
0.2
0.4
0.6
0.8
1
1.2
A B C D E F G H I
Hospital
%
Term NICU %
*SA hospitals = 0.5%
Pregnancy Outcome in South Australia 2009page 72
Clinical and Maternity Performance Indicators
Figure 29f: SPMR (Standardized Perinatal Mortality Ratio) for all births, SA hospitals with >=500 births per
year, 2009
0
50
100
150
200
250
300
A B C D E F G H I
Hospital
SPMR
*SA hospitals
Figure 29g: SPMR (Standardized Perinatal Mortality Ratio) for all births, SA hospitals with >=500 births per
year, 2005-2009
0
50
100
150
200
A B C D E F G H I
Hospital
SPMR
*SA hospitals
Pregnancy Outcome in South Australia 2009 page 73
Clinical and Maternity Performance Indicators
VI. Trends In Perinatal Statistics In South Australia,1981-2009
Perinatal statistics are presented in Tables 47 and 48 for both socio-demographic and obstetric aspects for each
year from 2000-2009, 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 1985-2008. The trends noted between 1981 and 2009 are as follows:
1. The total fertility rate stabilising at 1.87 live births per woman, in 2009 following a steady increase from 1.71 in
2000 to 1.91 live births per woman in 2008.
2. The increase in the proportion of Asian women from 1.8% in 1981 to 8.1% in 2009 and of Aboriginal women
from 1.5% in 1981 to 3.1% in 2009.
3. The decrease in the proportion of teenage women giving birth from 7.8% in 1981 to 4.1% in 2009. Over the
past decade, there has been a general decline in both the teenage birth and abortion rate. The teenage pregnancy
rate in 2009 of 32.7 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 21.1% in 2009, and among primiparous women from 1.2% to 12.8%. 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 28.27 years.
5. The proportion of single women giving birth peaked in 1996 at 14.9%, since within time there has been a gradual
decrease to 11.2% in 2009, 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 19.9% in 2009. The proportion of births in teaching hospitals was highest
in 2000 at 54.6%, and following a low of 49.6% in 2002, has gradually increased to 53.7 in 2009. In 2009
metropolitan private hospitals accounted for 25.7% of births. The number of births in birthing units in teaching
hospitals increased from 125 (0.6%) in 1992 to 1,166 (5.9%) in 2009. Home births increased from 44 (0.2%) in
1997 to 134 (0.7%) in 2009.
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. The decline is likely to be related to the increasing use of single embryo transfer in assisted
conception practice.
8. The induction rate increased from 22.1% in 1981 to 29.3% in 2002, after which it declined slightly. It was 29.4%
in 2009. Fifty-three percent of inductions in 2009 were performed for other than defined indications.
9. The fall in the proportion of normal spontaneous vaginal births (from 66.1% in 1981 to 55.4% in 2009, but
stable for the last five years), breech births (from 1.1% to 0.4%) and forceps births (from 15.2% to 4.6%). The
proportion delivered by ventouse increased from 0.7% to 7.2%, and by caesarean section, from 16.9% in 1981
to 32.4% in 2009. 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 (7.3% in 2009). The proportion of preterm births also
increased from 5.5% in 1981 to a peak of 9.0% in 2005 and 2009.
11. The proportion of births with congenital abnormalities identified before discharge from hospital after birth has
been relatively stable at 2.3%-2.7% during the last decade (2.7% in 2008 and 2009).
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.
13. The proportion of babies utilising neonatal intensive care has decreased from 3.0% in 2000 to 2.9% in 2009,
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% (2.2% in 2009).
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 4.9 per 1,000 births in 2009, while the rate for
international statistics (for births of 1,000g or 28 weeks if birthweight unavailable) has fallen from 7.2 to 4.0 per
Pregnancy Outcome in South Australia 2009page 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 0.9 per 1,000 livebirths in 2009. 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 65.1 in 2009 compared with 117.6
in 1981, with fluctuations in the last decade.
Table 47: Socio-demographic aspects of perinatal statistics, South Australia, 1981 and 2000 2009
Characteristic
Year
1981 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
1 Total births 19,052 17,872 17,704 17,745 17,844 17,522 18,196 18,803 19,757 19,970 19,901
2 Live births 18,905 17,765 17,584 17,623 17,710 17,409 18,067 18,663 19,624 19,819 19,761
3 Women who gave birth 18,857 17,578 17,427 17,421 17,517 17,229 17,897 18,519 19,471 19,672 19,604
4 Total fertility rate
per woman 1.75 1.71 1.71 1.73 1.75 1.74 1.82 1.82 1.91 1.91 1.87
5 Place of birth (%)
Teaching hospital 52.2% 54.6% 51.6% 49.6% 50.6% 49.9% 51.6% 52.1% 52.6% 53.2% 53.7%
Private hospital 19.7% 21.9% 25.2% 27.9% 28.1% 27.2% 26.5% 26.7% 26.6% 26.5% 25.7%
Country hospital 27.8% 23.5% 22.9% 22.2% 21.3% 22.5% 21.6% 20.8% 20.2% 20.3% 19.9%
Domiciliary* 0.3% 0.2% 0.2% 0.3% 0.3% 0.4% 0.3% 0.5% 0.5% 0.5% 0.7%
(65) (35) (37) (48) (60) (67) (63) (87) (107) (101) (134)
6 Race (%)
Aboriginal 1.5% 2.5% 2.3% 2.5% 2.7% 2.8% 2.7% 3.0% 3.0% 3.2% 3.1%
(Women who gave birth) (277) (446) (399) (445) (468) (484) (487) (548) (578) (624) (607)
(Births) (280) (450) (401) (452) (473) (491) (492) (559) (590) (637) (618)
Asian 1.8% 4.5% 4.4% 4.8% 4.7% 4.8% 5.3% 5.1% 6.2% 7.0% 8.1%
7 Age
Mean age (years) 26.55 29.50 29.52 29.62 29.77 29.81 29.86 30.01 30.05 30.11 30.14
Teenage (%) 7.8% 5.3% 5.4% 5.6% 5.4% 5.3% 5.2% 4.8% 4.6% 4.5% 4.1%
?35 years (%) 4.6% 16.2% 16.3% 17.0% 17.6% 17.9% 18.7% 20.4% 20.2% 21.1% 21.1%
8 Marital status (%)
Never married 7.6% 12.0% 12.3% 12.3% 11.9% 11.8% 12.5% 11.7% 11.0% 10.7% 10.0%
Widowed/ divorced/
separated (%)
2.0% 1.7% 1.6% 1.6% 1.5% 1.3% 1.3% 1.3% 1.4% 1.2% 1.2%
(Single) (9.6%) (13.7%) (13.9%) (13.9%) (13.3%) (13.0%) (13.8%) (13.0%) (12.5%) (11.9%) (11.2%)
9 Primiparae
Mean age (years) 24.42 27.61 27.66 27.77 27.91 28.13 28.02 28.20 28.30 28.24 28.27
Teenage 15.4% 10.6% 10.9% 11.3% 10.9% 10.0% 10.1% 9.5% 8.9% 8.8% 8.4%
?35 years 1.2% 9.3% 9.5% 9.9% 10.6% 11.0% 11.4% 12.6% 12.5% 12.7% 12.8%
*includes unplanned home births
Pregnancy Outcome in South Australia 2009 page 75
Trends in Perinatal Statistics in South Australia
Table 48: Obstetric aspects of perinatal statistics, South Australia, 1981 and 2000 2009
Characteristic
Year
1981 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
1 Plurality
Multiple births (%) 2.0% 3.3% 3.1% 3.6% 3.6% 3.3% 3.3% 3.0% 2.9% 3.0% 3.0%
Twins (363) (560) (550) (632) (626) (578) (570) (552) (544) (592) (578)
Triplets (21) (21) (3) (12) (21) (6) (21) (12) (21) (3) (12)
Quadruplets (0) (0) (0) (0) (0) (0) (0) (0) (0) (0) (0)
2 Induction of labour (%) 22.1% 27.3% 28.3% 29.3% 29.0% 27.9% 28.3% 28.9% 29.8% 28.6% 29.4%
3 Method of birth
Normal
spontaneous
66.1% 61.7% 59.5% 58.7% 57.8% 55.9% 55.8% 56.0% 56.0% 56.0% 55.4%
Elective caesarean 8.2% 10.4% 11.9% 12.6% 13.3% 14.0% 14.6% 15.5% 15.3% 15.4% 15.7%
Emerg caesarean 8.7% 14.8% 15.8% 16.6% 16.7% 17.6% 17.6% 17.4% 17.1% 16.8% 16.7%
Forceps 15.2% 6.4% 6.1% 5.9% 4.8% 5.0% 4.2% 3.7% 4.1% 4.2% 4.6%
Breech 1.1% 0.4% 0.4% 0.4% 0.4% 0.4% 0.4% 0.4% 0.4% 0.5% 0.4%
Ventouse 0.7% 6.3% 6.3% 5.9% 6.9% 7.1% 7.3% 7.0% 7.1% 7.1% 7.2%
Total caesarean (16.9%) (25.2%) (27.8%) (29.2%) (30.0%) (31.5%) (32.3%) (32.9%) (32.3%) (32.2%) (32.4%)
4 Birthweight <2,500g 5.8% 7.2% 6.8% 7.1% 7.0% 7.0% 7.6% 7.0% 6.9% 7.0% 7.3%
Singletons 4.9% 5.6% 5.5% 5.4% 5.3% 5.3% 5.9% 5.5% 5.5% 5.5% 5.7%
Multiples 52.1% 55.9% 46.3% 50.5% 53.0% 55.8% 57.7% 53.4% 53.6% 53.4% 59.8%
5 Gestational age <37
weeks 5.5% 8.6% 8.1% 8.3% 8.4% 8.7% 9.0% 8.2% 8.5% 8.6% 9.0%
Singletons 4.8% 6.9% 6.7% 6.6% 6.7% 7.0% 7.3% 6.8% 7.1% 7.0% 7.2%
Multiples 41.1% 57.3% 50.8% 52.2% 54.6% 58.4% 58.4% 54.4% 57.2% 59.3% 67.5%
6 Congenital abnormalities 3.4% 2.3% 2.5% 2.4% 2.3% 2.5% 2.5% 2.3% 2.6% 2.7% 2.7%
7 Level II care Na 15.8% 15.2% 15.8% 16.6% 16.6% 16.2% 15.3% 16.1% 15.4% 15.3%
8 Level III care 3.3% 3.0% 2.6% 2.8% 2.7% 2.9% 2.9% 2.5% 2.3% 2.5% 2.9%
9 W&CH ICU care Na 0.2% 0.3% 0.2% 0.2% 0.2% 0.3% 0.2% 0.3% 0.3% 0.3%
10 Hospitalisation for 28
days or more 4.2% 2.5% 2.1% 2.2% 2.2% 2.3% 2.4% 2.0% 2.1% 2.2% 2.2%
11 Neonatal deaths 96 57 64 54 42 52 63 38 55 51 49
12 Stillbirths 147 106 120 122 134 113 129 140 132 151 140
13 Perinatal deaths 243 163 184 176 176 165 192 178 188+ 202 189
14 Perinatal mortality rate
per 1,000 births
?400g/20 weeks 12.8 9.1 10.4 9.9 9.9 9.4 10.6 9.5 9.5 10.1 9.5
?500g/22 weeks* 11.6 6.1 6.9 6.8 6.5 5.7 6.2 4.9 5.2 5.3 4.9
?1,000g/28 weeks* 7.2 3.6 3.9 4.0 3.9 3.5 3.7 3.1 2.6 3.4 3.5
15 Standardized perinatal
mortality ratio 117.6 62.0 70.6 70.3 68.1 66.9 66.5 63.0 65.1 67.3 65.1
* 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 2009page 76
Trends in Perinatal Statistics in South Australia
Trends in Perinatal Statistics in South Australia (SA), 1985 2009
Figure 30a: Percentage of teenage women among women giving birth 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
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
20
08
20
09
Year
Pe
rc
en
ta
g
e
Figure 30b: Percentage of women aged 35 years and over among women giving birth in SA
0
4
8
12
16
20
24
19
85
19
86
19
87
19
88
19
89
19
90
19
91
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
20
08
20
09
Year
Pe
rc
en
ta
g
e
Figure 30c: Percentage of primiparous women aged 35 years and over in SA
0
5
10
15
19
85
19
86
19
87
19
88
19
89
19
90
19
91
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
20
08
20
09
Year
Pe
rc
en
ta
g
e
Pregnancy Outcome in South Australia 2009 page 77
Trends in Perinatal Statistics in South Australia
Figure 30d: Percentage of Aboriginal women and Asian women among women giving birth in SA
0
2
4
6
8
10
19
85
19
86
19
87
19
88
19
89
19
90
19
91
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
20
08
20
09
Year
Pe
rc
en
ta
g
e
Asian Aboriginal
Figure 30e: Percentage of women never married and with no de facto partner among women giving birth
in SA
0
3
6
9
12
15
19
85
19
86
19
87
19
88
19
89
19
90
19
91
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
20
08
20
09
Pe
rc
en
ta
g
e
Figure 30f: Percentage of multiple births among births in SA
0
1
2
3
4
19
85
19
86
19
87
19
88
19
89
19
90
19
91
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
20
08
20
09
Year
Pe
rc
en
ta
g
e
Pregnancy Outcome in South Australia 2009page 78
Trends in Perinatal Statistics in South Australia
Figure 30g: Percentage of low birthweight babies among births 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
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
20
08
20
09
Year
Pe
rc
en
ta
g
e
Figure 30h: SA standardised perinatal mortality ratio (SPMR)
0
50
100
150
19
85
19
86
19
87
19
88
19
89
19
90
19
91
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
20
08
20
09
Year
SP
M
R
Pregnancy Outcome in South Australia 2009 page 79
Trends in Perinatal Statistics in South Australia
VII. Summary Statistics For 2009
These statistics refer to all live births of any gestation as well as stillbirths of at least 400g birthweight or 20 weeks
gestation. Sixty-four babies of less than 400g birthweight have been included.
1. Number of births
Reported number of births (from monthly notifications): 19,901
Notified births with Supplementary Birth Records: 19,901
Notified women who gave birth with SBRs: 19,604
Crude birth rate: 12.3 live births per 1,000 population.
Total fertility rate: 1.87 live births per woman
2. Place of birth
Home births: 134 home births in all (0.7%), of which 125 were planned home births (0.6% of births in the state).
Metropolitan teaching hospitals: 10,680 (53.7%)
Metropolitan private hospitals: 5,119 (25.7%)
Country hospitals: 3,967 (19.9%)
3. Sex
Males 10,338, Females 9,563. Male: Female sex ratio = 1.08:1
4. Plurality and condition at birth
Condition at birth
Plurality
Total
Singleton Twins Triplets
Live birth 19,180 569 12 19,761
Stillbirth 131 9 0 140
Total 19,311 578 12 19,901
5. Race of women
Race Number of women %
Caucasian 19,655 85.0
Aboriginal 607 3.1
Asian 1,585 8.1
Other 757 3.8
Total 19,604 100.0
Pregnancy Outcome in South Australia 2009page 80
Trends in Perinatal Statistics in South Australia
6. Obstetric interventions in 19,604 women who gave birth
Induction of labour was performed for 5,770 women (29.4%) and labour was augmented for another 4,286 women
(21.9%) who gave birth.
Forceps were utilised for 902 women (4.6%), ventouse in 1,416 (7.2%) and episiotomy was performed for 2,245
women who gave birth (11.5%, or 16.9% of women who gave birth vaginally).
Caesarean section was performed in 6,357 women who gave birth (32.4%), of which 3,084 (15.7%) were elective,
and 3,273 (16.7%) emergency operations.
7. Low birthweight (<2,500g)
Number of singleton births of low birthweight =1,105 (5.7% of singleton births).
Number of multiple births of low birthweight =353 (59.8% of multiple births).
Number of all births of low birthweight =1,458 (7.3% of all births).
8. Congenital abnormalities
Births notified with congenital abnormalities: 539 (2.7%).
9. Perinatal morality rates (numbers of deaths in parentheses)
Birthweight/Gestation
Stillbirth rate per
1,000 births
Neonatal death rate per
1,000 live births
Perinatal mortality rate
per 1,000 births
1 ?400g/20 weeks (including live births
of any gestation)
(140) 7.0 (49) 2.5 (189) 9.5
2 ?500g/22 weeks if birthweight
unavailable
(WHO National Statistics*)
(70) 3.5 (27) 1.4* (97) 4.9*
3 ?1,000g/28 weeks if birthweight
unavailable (WHO International/
Standard Statistics*)
(51) 2.6 (18) 0.9* (69) 3.5*
* Only neonatal deaths within the first 7 days of life are included.
10. Terminations of pregnancy
Total number of terminations notified: 5,054
Abortion rate per 1,000 women (15-44 years): 15.6
Total abortion rate per 1,000 women (15-44 years): 471.5
Total first abortion rate per 1,000 women (15-44 years): 313.5
Abortion proportion: 0.20
Pregnancy Outcome in South Australia 2009 page 81
Summary Statistics for 2009
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. 2006 Annual Report. Adelaide: Women s and Children s Hospital,
Children, Youth and Women s Health Service, 2009.
3. Maternal, Perinatal and Infant Mortality Committee. Maternal, Perinatal and Infant Mortality in South Australia
2008. Adelaide: SA Health, Government of South Australia, 2009.
4. Strategy and Operations Service, Statewide Services Division. Operational Policy, Guidelines and Standards for
Maternal and Neonatal Services in South Australia. Adelaide: Department of Human Services, 2000.
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. Seventh Annual Report - For the Year 2009. Adelaide: SA
Health, Government of South Australia, 2011.
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 2009page 82
Trends in Perinatal Statistics in South Australia
These reports are as follows:
The South Australian Birth Defects Register Annual Report (from 1986).1.
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
Australia s Mothers and Babies (from 1991) and 2.
Congenital anomalies in Australia (from 1981) 3.
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.
Pregnancy Outcome in South Australia 2009 page 83
References
14. Byron-Scott R. et al. A validation study of congenital heart defects in South Australia. Proceedings, Australian
Birth Defects Society. Annual Scientific Meeting. Sydney 1998.
15. Byron-Scott R. et al. A comparison of selected birth defects in Aboriginal and non-Aboriginal babies in South
Australia. Proceedings, Australian Birth Defects Society. Annual Scientific Meeting, Sydney 1998.
16. Byron-Scott R. Richardson M, Hiller J, Chan A, Haan E, Knight B, Adams P. The prevalence and validation of
congenital heart defects in South Australia, 1986-94. Proceedings of the 3rd Annual Congress of the Perinatal
Society of Australia and New Zealand, Melbourne, 1999. P153.
17. Chan A, Cundy PJ, Foster BK, Keane RJ, Byron-Scott R. Late diagnosis of congenital dislocation of the hip and
presence of a screening programme. South Australian population-based study. Lancet 1999;354:1514-17.
18. Chan A, Cundy PJ, Foster BK, Keane RJ, Byron-Scott R. Screening for congenital dislocation of the hip (letter).
Lancet 2000;355:232-33.
19. Chan A, Pickering J, Haan EA, Netting M, Burford A, Johnson A, Keane RJ. Folate before pregnancy : the
impact of a South Australian health promotion campaign on women and health professionals. Western
Australian Birth Defects Registry Twentieth Anniversary Scientific Symposium April 27-28, 2000. Perth,
Western Australia. Teratology 2000;62: 365.
20. Cheffins T, Chan A, Haan EA, Ranieri E, Ryall RG, Keane RJ, Byron-Scott R, Scott H, Gjerde EM, Nguyen A-M,
Ford JH, Sykes S. The impact of maternal serum screening on the birth revalence of Down s syndrome and the
use of amniocentesis and chorionic villus sampling in South Australia. Br J Obstet Gynaecol 2000;107:1453-9.
21. Chan A, Pickering J, Haan EA, Netting M, Burford A, Johnson A, Keane RJ. Folate before pregnancy :the
impact on women and health professionals of a population-based health promotion campaign in South
Australia. MJA 2001; 174:631-636.
22. Chan A, Foster BK, Cundy PJ. Invited commentary. Problems in the diagnosis of neonatal hip instablity. Acta
Paediatr 2001;90:836-9.
23. Metz MP, Ranieri E, Gerace RL, Priest KR, Luke CG, Chan A. Newborn screening in South Australia: is it
universal? MJA 2003;179:412-415.
24. Chan A. Invited commentary: Parity and the risk of Down syndrome caution in interpretation. Am J
Epidemiol 2003;158:509-511.
25. Gibson CS, MacLennan AH, Hague WM, Rudzki Z, Sharpe P, Chan A, Dekker GA. Fetal thrombophilic
polymorphisms are not a risk factor for cerebral palsy. Perinatal Society of Australia and New Zealand 8th
Annual Congress, Convention Centre, Darling Harbour, Sydney, Australia, 15th-18th March 2004, A41.
26. Gibson CS, MacLennan AH, Rudzki Z, Hague WM, Haan EA, Sharpe P, Priest K, Chan A, Dekker GA 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
Pregnancy Outcome in South Australia 2009page 84
References
Obstet Gynecol 2006;194: 674.e1-674.e11.
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.
Pregnancy Outcome in South Australia 2009 page 85
References
4. South Australian Health Commission, Epidemiology Branch. Variation in perinatal risk by place of residence of
mother in South Australia. Adelaide: South Australian Health Commission, December 1986.
5. South Australian Health Commission, Epidemiology Branch. Variations in Perinatal Risk by Hospital of Birth in
South Australia. Adelaide: South Australian Health Commission, January 1987.
6. South Australian Health Commission, Epidemiology Branch. Aboriginal Births in South Australia, 1981-1986:
An Analysis of Perinatal Outcomes, Adelaide: South Australian Health Commission, May 1988.
7. South Australian Health Commission, Epidemiology Branch: Pregnancy Outcome Attributes by Postcode: South
Australia 1981-1986. South Australian Health Commission, Adelaide: August 1988.
8. Jonas O, Scott J, Chan A, Macharper T, Lister J. A validation study of the 1986 perinatal data collection form.
Adelaide: Pregnancy Outcome Unit, South Australian Health Commission, 1991.
9. South Australian Cancer Registry. Associations between perinatal characteristics and risk of childhood cancer:
South Australian cancer cases born in 1981-1993. In: Epidemiology of Cancer in South Australia. Incidence,
Mortality and Survival 1977 to 1994. Adelaide South Australian Health Commission, 1995.
10. Taylor A, Twisk A-M, Chan A. Perinatal risk factors by postcode in South Australia 1989-1992. Epidemiology
Branch, South Australian Health Commission, Adelaide: June 1995.
11. Pregnancy Outcome Unit. Perinatal Statistics Collection. Guidelines for the Supplementary Birth Record.
Adelaide: South Australian Health Commission, December 1997.
12. McLean A, Scott J, Keane RJ, Sage L, Chan A. Validation of the 1994 South Australian perinatal data collection
form. Adelaide: Pregnancy Outcome Unit, Department of Human Services, 2001.
13. Hart G, MacHarper T, Moore D, Roder D. Aboriginal pregnancies and births in South Australia. MJA 1985;
143: S54-56.
14. Chan A, Roder D, Macharper, T. Obstetric Profiles of Immigrant Women from Non-English Speaking Countries
in South Australia, 1981-83. Aust NZ J Obstet Gynaecol 1988; 28: 90-95.
15. Jonas O, Roder D, Esterman A, Macharper T, Chan A. Pregnancy and Birth Risk Factors for Intellectual Disability
in South Australia. Eur J Epidemiol 1989; 5: 322-327.
16. Jonas O, Chan A, Macharper T, Roder D. Pregnancy and Perinatal Factors associated with persistently low
Apgar scores: an analysis of the birth records of infants born in South Australia. Eur J Epidemiol 1990; 6:
136-141.
17. Crotty M, Ramsay AT, Smart R, Chan A. Planned Homebirths in South Australia 1976-1987 MJA 1990; 153:
664-671.
18. Jonas O, Chan A, Roder D, Macharper T. Pregnancy Outcomes in primigravid women aged 35 years and over
in South Australia, 1986-1988. MJA 1991; 154: 246-249.
19. Zhang B, Chan A. Teenage Pregnancy in South Australia, 1986-1988. Aust. NZ J Obstet Gynaecol 1991;
31: 291-298.
20. Jonas O, Roder D, Chan A. The Association of Maternal and Socioeconomic Characteristics in Metropolitan
Adelaide with Medical, Obstetric and Labour Complications and Pregnancy Outcomes. Aust NZ J Obstet
Gynaecol 1992; 32: 1-5.
21. Chan A, Roder D, Priest K, Esterman A. A perinatal perspective on South Australia in the 1980s. MJA 1992;
157: 515-518.
22. Jonas O, Roder D, Chan A. The association of low socio-economic status in Metropolitan Adelaide with
maternal demographic and obstetric characteristics and pregnancy outcome. Eur J Epidemiol 1992; 8:708.
23. Jonas O, Roder D. Breech Presentation in South Australia, 1987-1989. Aust NZ J Obstet Gynaecol 1993;
33: 17-21.
24. Scott J, Chan A. Planned birthing unit deliveries in South Australia. Proceedings, 14th Annual Congress
Australian Perinatal Society, Adelaide, March 1996, P21.
25. Dal Grande E, Chan A, Keane R. Asian, but different: Obstetric characteristics of women born in Vietnam
and Philippines who delivered in South Australia in 1991-1994. Proceedings, 14th Annual Congress Australian
Perinatal Society, Adelaide, March 1996, P22.
Pregnancy Outcome in South Australia 2009page 86
References
26. Keane R, Dal Grande E, Chan A, McCaul K. Episiotomy a decline in the cutting edge. Proceedings, 14th
Annual Congress Australian Perinatal Society, Adelaide, March 1996, P75.
27. Chan A, McPhee AJ. A safer leap into this dangerous world. Lancet 1996; 348 (suppl II) :12.
28. Carter JR, Hiller JE, Ryan P, Chan A. The Association between maternal age and preterm births to primiparous
women in South Australia, 1991-1993, Proceedings, First Annual Congress, Perinatal Society of Australia and
New Zealand, Fremantle, Western Australia, 16-24 March 1997.
29. Zhang B, Hiller JE, Chan A. Asthma in pregnancy in South Australia. Proceedings, First Annual Congress,
Perinatal Society of Australia and New Zealand, Fremantle, Western Australia, 16-24 March 1997.
30. Roder D, Nguyen A-M, Chan A. Trends in perinatal characteristics in South Australia, 1981 to 1994, by place
of residence of mother. Aust NZ J Public Health 1997; 21: 483-8.
31. Zhang B, Hiller JE, Chan A. Asthma in pregnancy: Association with Spontaneous Preterm Birth. Proceedings of
the 3rd Annual Congress of the Perinatal Society of Australia and New Zealand, Melbourne, 1999, A113.
32. McLean AP, Hiller JE, Chan A. Maternal epilepsy and fetal outcomes in South Australia. Perinatal Society
of Australia and New Zealand 4th Annual Congress. Brisbane Convention and Exhibition Centre, Brisbane,
Australia, 12-15 March 2000, P192.
33. Chan A, Keane RJ, Robinson JS. The contribution of maternal smoking to preterm birth, small for gestational
age and low birthweight among Aboriginal and non-Aboriginal births in South Australia. MJA 2001;174:
389-93.
34. van der Klis KAM, Westenberg L, Chan A, Dekker G, Keane RJ. Teenage pregnancy: trends,characteristics and
outcomes in South Australia and Australia. Aust N Z J Public Health 2002; 26: 125-31.
35. Westenberg L, van der Klis KAM, Chan A, Dekker G, Keane RJ. Aboriginal teenage pregnancies compared with
non-Aboriginal in South Australia 1995-1999. Aust N Z J Obstet Gynaecol 2002;42: 187-191.
36. Wang JX, Knottnerus A-M, Schuit G, Norman RJ, Chan A, Dekker GA. Surgically obtained sperm and risk of
gestational hypertension and pre-eclampsia. Lancet 2002;359: 673-4.
37. Jacobs DJ, Vreeburg SA, Dekker GA, Heard AR, Priest KR, Chan A. Risk factors for hypertension during
pregnancy in South Australia. Aust NZ J Obstet Gynaecol 2003; 3: 421-428.
38. Heard AR, Dekker GA, Chan A, Jacobs DJ, Vreeburg SA, Priest KR. Hypertension during pregnancy in South
Australia, Part 1: Pregnancy outcomes. Aust NZ J Obstet Gynaecol 2004; 44: 404-409.
39. Vreeburg SA, Jacobs DJ, Dekker GA, Heard AR, Priest KR, Chan A. Hypertension during pregnancy in South
Australia, Part 2: Risk factors for adverse maternal and/or perinatal outcome results of multivariable analysis.
Aust NZ J Obstet Gynaecol 2004;44: 410-418.
40. Leahy K, Elliot E, Kennare R, Chan A. Characteristics and pregnancy outcomes of first time mothers aged
35 years and over compared to younger first time mothers in South Australia 1991-2002. Before and
Beyond Birth. Abstract Book. Perinatal Society of Australia and New Zealand 9th Annual Congress. Adelaide
Convention Centre, Adelaide, South Australia, 13-16 March 2005, A144.
41. Kennare R, Heard A, Chan A. Substance use during pregnancy: risk factors and obstetric and perinatal
outcomes in South Australia. Aust NZ J Obstet Gynaecol 2005;45:220-225.
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 RM, Keirse MJNC, Tucker GR, Chan AC. Planned home births in South Australia 1991-2006. MJA (In press).
Pregnancy Outcome in South Australia 2009 page 87
References
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.
Ade;laide 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 2009page 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 pregnancies resulting in live births or stillbirths.
Primipara: 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.
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:
Pregnancy Outcome in South Australia 2009 page 89
References
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 2009page 90
Appendix
Crude birth rate:
Average population in that year
Number of live births in any year
x 1,000=
Age-specific fertility rate:
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
General fertility rate:
Total number of live births in a year
Estimated resident population of women aged 15-44 years in the same year
x 1,000
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.1
1 World Health Organisation. International Statistical Classification of Diseases and Related Health Problems. Tenth Revision. Volume 2.
Geneva: WHO, 1993, p 134.
Pregnancy Outcome in South Australia 2009 page 91
Appendix
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:
Live births
Abortion
Total abortion rate = the sum of the five-year age-specific abortion rates multiplied by 5.
This represents the number of abortions 1,000 women would have during their lifetime if they experienced the rates
of the year shown.
Pregnancy Outcome in South Australia 2009page 92
Appendix
Appendix 2: 2009 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
2009 SUPPLEMENTARY BIRTH RECORD
Mother s name .............................................................................................................................
Surname Given Names
Child s surname (if different) ........................................................................................................
Mother s address .........................................................................................................................
..................................................................................................... Postcode
Personal information above this line is con?dential SLA
MOTHER S INFORMATION
1 Mother s date of birth
day month year
2 Race
1. Caucasian
2. Aboriginal
3. Asian
4. Torres Strait Islander (TSI)
5. Aboriginal & 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
4 0 9
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 2009 page 93
Appendix
Appendix 3: Congenital Abnormality Form
Pregnancy Outcome in South Australia 2009page 94
Appendix
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 require this information in an alternative language or format please contact
SA Health on the details provided above and they will make every effort to assist you.
Department of Health, Government of South Australia.
All rights reserved. ISSN: 0819-3835
FIS: 11105.1. Printed July 2011.
Acknowledgements
Executive Summary
I. Introduction
II. Mothers and Babies: Characteristics and Outcomes
III. Terminations of Pregnancy
IV. Obstetric Profiles by Hospital Category
V. Clinical and Maternity Performance Indicators
VI. Trends in Perinatal Statistics in South Australia, 1981 2008
VII. Summary statistics for 2008
References
Publications
Annual Reports
Other reports/papers
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