Australian-first research saving babies

Professor Euan Wallace and
Dr Miranda Davies-Tuck

A highly successful research project at Monash University’s The Ritchie Centre has contributed to a significant reduction in stillbirth at Monash Health – Victoria’s largest maternity service.

A testament to the project’s impact on healthcare, the Below 100: Preventing Stillbirth program was an award winner for improving healthcare through clinical research in this year’s Victorian Public Healthcare Awards.

Stillbirth is a devastating outcome for women, their partners and families. 

Unfortunately, the rate of stillbirth in Victoria has remained unchanged for more than 20 years. In particular, the rate of late pregnancy stillbirth (losses after 36 weeks) has been most stubborn to change.

The collaborative research project led by The Ritchie Centre’s Professor Euan Wallace and Dr Miranda Davies-Tuck has underpinned Monash Health’s drive to be the safest maternity service in Victoria.

The most robust measure of perinatal mortality rates, including stillbirth, is the Gestation Standardised Perinatal Mortality Ratio (GSPMR), a scale that accounts for gestation at birth and allows comparisons across hospitals. 

By definition, the Victorian state-wide GSPMR is 100, i.e. the average. Any hospital with a GSMPR below 100 has a lower perinatal mortality rate than average for the State, and any hospital above 100 has a higher than average rate.

“When we started this project in 2008, the overall GSMPR for Monash Health maternity hospitals was 115, or 15 per cent higher than State average,” said Professor Wallace, who is also Head, Department of Obstetrics and Gynaecology at Monash University and Director of Obstetrics Services at Monash Health.

“However, following the commencement of this research program and the associated changes in clinical care, the GSPMRs have fallen across all three hospitals. The Monash Health average is now 78 – more than 20% better than the State average.”

In order to improve GSPMR rates, Professor Wallace started the Below 100 research program to better understand the causes of stillbirth, with the aim of changing clinical care to address these causes.

“We identified opportunities for improvements in three areas of clinical care: 1) antenatal care; 2) the detection of fetal growth restriction; and 3) late pregnancy fetal surveillance,” said Dr Davies-Tuck.

“Our analysis revealed that women who had received their antenatal care in the community rather than in a hospital clinic had a significantly higher GSPMR.”

“Another part of the project showed that women of South Asian birth were more than twice as likely to have a stillbirth or a growth restricted baby as other women,” added Dr Davies-Tuck.

Growth restriction is associated with a seven-fold increased risk of stillbirth.

“Our data has informed targeted changes in our clinical practice, including establishing a new pregnancy clinic at Dandenong Hospital.”

The new Dandenong clinic has seen a dramatic increase in the number of women receiving antenatal care by Monash Health from 25% in 2013 to 80% in 2015.

“We have also developed new clinical practice guidelines to improve the detection of fetal growth restriction and to commence post-term surveillance in South Asian women at 39 weeks gestation instead of 41 weeks,” said Professor Wallace.

“Our initiatives have led to significant decreases in the GSPMR at all three maternity hospitals, equivalent to about five fewer stillbirths per year at Monash Health.”

If replicated across the state, this would equate to nearly 50 fewer stillbirths in Victoria each year.

Professor Wallace said that recognising the importance of maternal ethnicity in the risk of stillbirth and using this to better target individualise care is an Australian first.

“Every bit as exciting, our research has led to advances in fundamental placental biology that promise predictive testing and preventative therapies into the future.”