Annabelle Chan

Abstract:  Classifications of perinatal deaths have been undertaken for surveillance of causes of death, but also for auditing individual deaths to identify suboptimal care at any level, so that preventive strategies may be implemented. This paper describes the history and development of the paired obstetric and neonatal Perinatal Society of Australia and New Zealand (PSANZ) classifications in the context of other classifications. The PSANZ Perinatal Death Classification is based on obstetric antecedent factors that initiated the sequence of events leading to the death, and was developed largely from the Aberdeen and Whitfield classifications. The PSANZ Neonatal Death Classification is based on fetal and neonatal factors associated with the death. The classifications, accessible on the PSANZ website (http://www.psanz.org), have definitions and guidelines for use, a high level of agreement between classifiers, and are now being used in nearly all Australian states and New Zealand.

The period total first abortion rate (TFAR) has been used to estimate the proportion of women who will experience an induced abortion in their reproductive lifetime. It is a hypothetical measure as age-specific rates currently existing will change with time. Instead, a cohort TFAR has been calculated for women born around 1955 using legal-abortion reports in South Australia to calculate first abortion rates for each year of age from 15 years to 44 years for 1971–2000, respectively, and summing these. Yearly fertility rates were also calculated for this cohort to further describe their reproductive experience. Yearly first abortion rates were also calculated for later cohorts born in 1960–1980. The 1955 cohort TFAR was 288.1 per 1,000 women aged 15–44 years. Cumulative first abortion rates at specific ages were higher for subsequent cohorts (e.g., 309.6 per 1,000 at age 40 years for the 1960 cohort). Thus, about 29% of South Australian women born around 1955 and exposed to legal abortion throughout their reproductive lifetime experienced an induced abortion. This proportion would be higher for later cohorts of women born in 1960–1980 (e.g., at least 31% for those born in 1960).

Received for publication April 17, 2003; accepted for publication April 22, 2003.

To evaluate a South Australian campaign to promote and implement knowledge that taking adequate folate/folic acid in the periconceptional period can reduce the risk of having a baby with a neural tube defect. The campaign, conducted in October 1994--August 1995, targeted women of reproductive age and health professionals. Evaluation was by computer-assisted telephone interviews undertaken by random dialling throughout the State before and after the campaign, and by self-administered questionnaires to health professionals and women in the postnatal period. Women of reproductive age and four groups of health professionals. Knowledge about folate, folate-rich foods and the periconceptional period; participation of health professionals in advising women about folate; use of periconceptional folic acid supplements; sales of folic acid tablets; and prevalence of neural tube defects. Significant increases in knowledge about folate followed the campaign. Health professionals and women in the postnatal period had higher initial levels of knowledge about folate, which also increased significantly. The proportions of women taking periconceptional folic acid supplements, and of health professionals advising women planning a pregnancy about folate, also increased significantly, and folic acid tablet sales doubled. Total prevalence of neural tube defects declined between 1966 and 1999 from a baseline of 2.0 per 1,000 births to 1.1 per 1,000 births (Poisson regression, P= 0.03; average decline of 1.0% per year). A short educational campaign with a limited budget ($40,000) can promote folate successfully, but alternative strategies such as food fortification are likely to be needed to achieve adequate periconceptional folate intake for a very high proportion of women.

Objectives To determine the contribution of maternal smoking to preterm birth (< 37 weeks' gestation), small for gestational age (SGA, birthweight < 10th percentile for gestational age) and low birt...