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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.”
