Dr Euan Wallace, Director, Monash University -

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Information about Dr Euan Wallace, Director, Monash University -
Health & Medicine

Published on March 19, 2014

Author: informaoz

Source: slideshare.net

Description

Dr Euan Wallace, Director, The Ritchie Centre, Monash University delivered this presentation at the 2013 Obstetric Malpractice Conference. This is the only national conference for the prevention, management and defence of obstetric negligence claims.

For more information, go to http://www.healthcareconferences.com.au/obstetric13

Race-based Care: is that good medicine? Professor Euan M Wallace The Ritchie Centre, Monash Institute of Medical Research Department of Obstetrics and Gynaecology, Monash University Monash Women’s Services, Monash Health the RITCHIE CENTRE

the RITCHIE CENTRE What defines a good pregnancy outcome? a satisfied mother

the RITCHIE CENTRE What defines a good pregnancy outcome? - normal vaginal birth - intact perineum - successful breastfeeding - healthy baby - no postnatal depression - no “other” complication (bleeding, infection)

the RITCHIE CENTRE no mention of race or ethnicity

the RITCHIE CENTRE 75% Australian born mothers

the RITCHIE CENTRE 40% Australian born mothers

the RITCHIE CENTRE Is ethnicity associated with pregnancy outcome? - normal vaginal birth - intact perineum - successful breastfeeding - healthy baby - no postnatal depression - no “other” complication (bleeding, infection) What defines a good pregnancy outcome?

the RITCHIE CENTRE Is ethnicity associated with pregnancy outcome? - normal vaginal birth - intact perineum - successful breastfeeding - healthy baby - no postnatal depression - no “other” complication (bleeding, infection)

the RITCHIE CENTRE Monash Medical Centre level 6 maternity unit 3800 births pa Dandenong Hospital level 5 maternity unit 2500 births pa Casey Hospital level 4 maternity unit 1500 births pa

the RITCHIE CENTRE ns p<0.01 p<0.01 Mode of birth, by maternal region of birth No(%)women

the RITCHIE CENTRE South Asian women are twice as likely as Australian-born women to have an emergency intrapartum caesarean section

the RITCHIE CENTRE ns P<0.01 Pregnancy & birth outcomes, by maternal region of birth ns ns P<0.05 P<0.05 No(%)women

the RITCHIE CENTRE South East/East Asian women are almost half as likely as Australian-born women to have an intact perineum following vaginal birth South Asian women are twice as likely as Australian-born women to have severe perineal trauma

Odds ratio (95%CI) of stillbirth ≥ 37 weeks 1.0 2.4 (1.4-4.0) 0.7 (0.4-1.2) <0.0001 = RR for >41 wks

the RITCHIE CENTRE customized fetal growth charts

Customized growth charts will likely increase the stillbirth rate, not reduce it Customised charts assumes that variations in birthweight related to maternal characteristics are physiological and not associated with pathological (adverse) outcomes. Inclusion of maternal characteristics that have a pathological (adverse) influence on growth would inappropriately normalise SGA in an infant at increased risk of stillbirth (ie “hide” the at risk fetus) So, do customised growth charts normalise (hide) the at risk SGA fetus?

1. Infants of small mothers are more likely to be SGA than larger mothers 2. SGA infants of small mothers are at higher risk of stillbirth than AGA infants

Customized defined SGA Population defined SGANNM hazard ratio vs whites: 2.10 Revealed SGA hazard ratio vs whites: 2.16 Revealed SGA hazard ratio vs whites: 1.10

the RITCHIE CENTRE Pregnancy outcomes differ by maternal ethnicity? - need for post-term induction - risk of intrapartum fetal compromise - rate of intact perineum - rate of severe perineal trauma - rate of growth restriction - rate of late pregnancy stillbirth the challenge is to identify mechanisms and tailor care accordingly

the RITCHIE CENTRE

the RITCHIE CENTRE Acknowledgements Monash Health Michelle Knight Amanda Knight The Ritchie Centre Miranda Davies-Tuck Henry Drysdale Monash University Mary Anne Biro Christine East

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