Samantha J. Lain

Administrative or population health datasets (PHDS) are increasingly being used for research related to maternal and infant health. However, the accuracy and completeness of the information in the PHDS is important to ensure validity of the results of this research. To compile and review studies that validate the reporting of conditions and procedures related to pregnancy, childbirth, and newborns and provide a tool of reference for researchers. A systematic search was conducted of Medline and EMBASE databases to find studies that validated routinely collected datasets containing diagnoses and procedures related to pregnancy, childbirth, and newborns. To be included datasets had to be validated against a gold standard, such as review of medical records, maternal interview or survey, specialized register, or laboratory data. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and/or κ statistic for each diagnosis or procedure code were calculated. Forty-three validation studies were included. Under-enumeration was common, with the level of ascertainment increasing as time from diagnosis/procedure to birth decreased. Most conditions and procedures had high specificities indicating few false positives, and procedures were more accurately reported than diagnoses. Hospital discharge data were generally more accurate than birth data, however identifying cases from more than 1 dataset further increased ascertainment. This comprehensive collection of validation studies summarizing the quality of perinatal population data will be an invaluable resource to all researchers working with PHDS.

Background:  In 2004, the Federal Government introduced the baby bonus, a one‐off payment upon the birth of a child.Aims:  To assess the impact of an increase in the number of births on maternity services in New South Wales following the introduction of the baby bonus payment in July 2004.Methods:  A population‐based study, using NSW birth records, of 965 635 deliveries from 1998 to 2008 was carried out. The difference between the predicted number of births in 2005–2008, estimated from trends in births from 1998 to 2004, and the observed number of births in NSW hospitals in 2005–2008 were calculated. We also estimated the increase in cost to the health system of births in 2008 compared with previous years.Results:  Compared with trends prior to the introduction of the baby bonus, there were an estimated 11 283 extra singleton births per year in NSW hospitals by 2008. There were significant increases in the number of deliveries performed in tertiary, urban and rural public hospitals; however, the number of deliveries in private hospitals remained stable. Compared with predicted estimates, in 2008, there were over 8700 more vaginal deliveries, over 1000 more preterm births and over 45 000 extra infant hospital days each year. Compared with 2004, in 2008, the estimated cost of births in NSW hospitals increased by $60 million,Conclusions:  The increase in births following the introduction of the baby bonus has significantly impacted maternity services in NSW.

Linking population health data to pathology data is a new approach for the evaluation of predictive tests that is potentially more efficient, feasible and efficacious than current methods. Studies evaluating the use of first trimester maternal serum levels as predictors of complications in pregnancy have mostly relied on resource intensive methods such as prospective data collection or retrospective chart review. The aim of this pilot study is to demonstrate that record-linkage between a pathology database and routinely collected population health data sets provides follow-up on patient outcomes that is as effective as more traditional and resource-intensive methods. As a specific example, we evaluate maternal serum levels of PAPP-A and free β-hCG as predictors of adverse pregnancy outcomes, and compare our results with those of prospective studies.

Anaesthesia guidelines recommend regional anaesthesia for most caesarean sections due to the risk of failed intubation and aspiration with general anaesthesia. However, general anaesthesia is considered to be safe for the foetus, based on limited evidence, and is still used for caesarean sections.

Objective: To assess the change in birth rates, both overall and in age, parity, socioeconomic and geographical subgroups of the population, after the introduction of the Baby Bonus payment in Austra...

Background: Routinely collected datasets are frequently used for population‐based research but their accuracy needs to be assured.Aim: This study aims to assess the accuracy of hospital discharge data in identifying obstetric haemorrhage diagnoses and procedures, and estimate their population incidence.Methods: The medical records of 1200 randomly selected women were reviewed and compared with obstetric haemorrhage diagnoses and procedures in the hospital discharge data. Sensitivity, specificity, and positive and negative predictive values were calculated using the medical records as the ‘gold standard’. Estimates of population incidence were calculated and weighted by the sampling probabilities.Results: Estimated population incidence for any antepartum haemorrhage was 1.8 per 100, and post partum haemorrhage was 7.2 per 100 women. Obstetric haemorrhage diagnosis and procedure codes tended to be underreported, with sensitivities ranging from 28.3% to 100%. All codes had specificities of 98.9% or greater. The identification of obstetric haemorrhage differed between levels of severity.Conclusion: The results indicate that population health datasets can be a reliable information source; however, these datasets could be improved with more complete documentation in medical records.

Objective: To investigate whether changes in maternal and birth characteristics explain the increase in the use of epidural analgesia during labor.Methods: Using data from a statewide surveillance system of all births, the study included 857 667 women who labored at term between 1992 and 2003 in New South Wales, Australia. Annual rates of epidural analgesia use were calculated. Logistic regression models were used to predict epidural analgesia rates over time, and were compared with observed rates.Results: Epidural analgesia use increased from 17.2% in 1992 to 26.5% in 2003. The increase in the proportion of women with factors associated with epidural analgesia use explained almost half of the increase in rate. After controlling for these factors, the odds of a woman receiving epidural analgesia in 2003 compared with 1992 were 1.42 (95% CI, 1.38–1.46).Conclusion: Changes in maternal or birth characteristics partially explain the increase in epidural analgesia rate. The unexplained increase may be due to increased availability or other factors.