Are you switched on?

1. Are you switched on? Perinatal Data Collection

2. Education session Presenter’s name

3. Agenda • Overview of current landscape • Revised data set: • new data items • user manual • Electronic or paper – what are we doing from 1 January 2009? • Trial of electronic transmission

4. Current landscape Victorian Perinatal Data Collection Unit (VPDCU) is authorisedto collect information on every birth in Victoria over 20 weeks gestation or more than 400gms birth weight. • Review of data elements has been in progress since 2006 • national data reporting requirements • capture mortality information. • Data is collected, analysed and reported annually for a calendar year.

5. A revised perinatal data collection will be implemented as of 1 January 2009.

6. New data items • What are the new or modified data items? • Why are the VPDCU collecting them? • How will they be used by the VPDCU?

7. Setting of birth – intended and actual • The intended place of birth at the time of booking: • the name of the hospital where the birth was intended to take place is now required. • The actual place where the birth occurred: • the name of the hospital where the birth occurred is now required.

8. Setting of birth – change of intent – reason • Reason for change of intent between where the mother intended to give birth and where the actual birth took place: • 1 Recognition of higher risk • 2 Actual complication of pregnancy • 3 Social or geographic e.g. moved house, preference • 4 Unintended/unplanned • 8 Other • 9 Not stated / inadequately described.

9. Maternal smoking < 20 wks • Cigarette smoking before 20 weeks gestation: • 1 No smoking at all before 20 weeks of pregnancy • 2 Quit smoking during pregnancy (before 20 weeks) • 3 Continued smoking before 20 weeks of pregnancy • 9 Not stated / inadequately described.

10. Maternal smoking > 20 wks • Cigarette smoking at 20 or more weeks gestation: • 00 No smoking at 20 or more weeks gestation. • NN Average number of cigarettes smoked per day at 20 or more weeks of pregnancy • 98 Occasional smoking (less than one) • 99 Not stated / inadequately described.

11. Indigenous status - baby • Indigenous status is a measure of whether a person (baby) identifies as being of Aboriginal or Torres Strait Islander origin and is accepted as such by the community in which they live.

12. Height and weight • A person's self-reported height, measured in centimetres at around the time of conception • Valid range: 100-250 • 999 (not stated). • Mother’s self-reported weight (body mass) around the time of conception • Valid range: 20-300 • 888 (unknown) • 999 (not stated).

13. Gravidity • The total number of pregnancies, including the current one: • record the numbers of known pregnancies regardless of the gestation and outcome • pregnancies of multiple fetuses should be counted as only one pregnancy. For example, a twin pregnancy is counted as one pregnancy, even though it has two outcomes.

14. Parity • The total number of previous pregnancies resulting in births at 20 or more weeks. • Record the number of known previous pregnancies that ended in births at 20 or more weeks gestation, that is, count all pregnancies that result in livebirths - survived 28 days, livebirths-neonatal death, and stillbirths. • Exclude the current pregnancy. • If this is the first pregnancy, record 00. • Pregnancies of multiple fetuses should be counted as only one pregnancy. For example, a twin pregnancy is counted as ‘1’ pregnancy, even though it has two outcomes.

15. Plan for VBAC • Whether, at the time of admission to hospital for the birth, the woman hoped to have a vaginal birth after one or more previous caesarean sections: • only reported when total number of previous caesareansis greater than zero.

16. Estimated date of confinement / agreed due date • The agreed estimated date of confinement / due date. • The estimated date of confinement may be based on the date of the last normal menstrual period (LNMP) or on clinical or ultrasound assessments. • If there is uncertainty in each of these report the agreed due date based on the best available information in the particular case. • Fill with 9s if unknown.

17. Gestational age at 1st antenatal visit • The number of completed weeks gestation at the time of the first antenatal visit (excluding a consultation for confirmation of pregnancy) as measured from the first day of the last normal menstrual period. • The first antenatal visit is the first visit to a midwife or doctor arranged specifically for the purpose of providing maternity care. It excludes visits for confirmation of pregnancy and medical visits for incidental problems while pregnant. • Record in completed weeks.

18. Maternal medical conditions - precoded • A new set of precoded conditions have been added: • O100 Pre-existing hypertension • O2431 Pre-existing diabetes mellitus, non-insulin treated • O2432 Pre-existing diabetes mellitus, insulin treated • O2681 Renal disease – specify • O993 Psychosocial problems – specify • O994 Diseases of the circulatory system – specify. • Please provide more specificity where required.

19. Obstetric complications - precoded • A new set of precoded conditions have been added: • O149 Pre-eclampsia • O2441 Diabetes mellitus arising at or after 24 weeks gestation, diet controlled • O2442 Diabetes mellitus arising at or after 24 weeks gestation, insulin treated • O365 Suspected fetal growth restriction • O440 Placenta praevia without haemorrhage • O441Placenta praevia with haemorrhage • O459 Premature separation of placenta (abruptio placentae) • O468 Other antepartum haemorrhage • Z223 Carrier of streptococcus group B (GBS+).

20. Discipline of antenatal care provider • The discipline of the clinician who provided most occasions of antenatal care.

21. Number of ultrasounds • Changes to gestation periods: • 10-14 Weeks • 15-26 Weeks • >27 Weeks

22. Procedure and operations - precoded • A new set of precoded conditions have been added: • 1651100 Cervical suture for cervical shortening • 9619703 Intramuscular administration of two doses of steroids antenatally.

23. Artificial reproductive technology - indicator • Whether artificial reproductive technology (ART) was used to assist this current pregnancy. • If ART was used record the type of ART in Procedures and operations,for example: IVF, Clomid, GIFT, ICSI.

24. Date and time of onset of labour • The date and time of onset of labour: • record a valid date and time • fill with 8s if the mother has a planned or unplanned caesarean section with no labour • 0000 and 2400 are invalid.

25. Date and time of onset of second stage • The date and time of the start of second stage of labour: • record a valid date and time • fill with 8s if the mother has a planned or unplanned caesarean section and did not reach second stage • 0000 and 2400 are invalid.

26. Date and time of rupture of membranes • The date on which the mother’s membranes ruptured (spontaneously or artificially): • record a valid date and time • fill with 8s if the mother has a planned or unplanned caesarean section and membranes were ruptured at caesarean • 0000 and 2400 are invalid.

27. Time of birth • The time of birth measured as hours and minutes using a 24-hour clock: • record a valid time • 0000 and 2400 are invalid.

28. Fetal monitoring in labour • Methods used to monitor the well being of the fetus during labour: • 01 None • 02 Intermittent auscultation • 03 Admission cardiotocography • 04 Intermittent cardiotocography • 05 Continuous external cardiotocography • 06 Internal cardiotocography (scalp electrode) • 07 Fetal blood sampling • 88 Other • 99 Not stated / inadequately described. • More than one method can be recorded.

29. Birth presentation • A new set of presentations have added: • 1 Vertex • 2 Breech • 3 Face • 4 Brow • 5 Compound • 6 Cord • 7 Shoulder • 8 Other – specify • 9 Not stated / inadequately described. • For a multiple pregnancy with differing presentations, record the presentation of the fetus for which the form is being completed.

30. Events of labour and birth • This has been split from the previous ‘Complications of Labour, Birth or Postnatal’ item. • Refers to medical and obstetric events arising after the onset of labour, during the labour and birth, including preparation for caesarean section.

31. Discipline of intrapartum care provider • The discipline of the clinician who is primarily responsible for making decisions regarding intrapartum care.

32. Prophylactic oxytocic in third stage • Whether an oxytocic was given prophylactically in the third stage of labour: • record ‘yes’ when an oxytocic is used in order to prevent heavy blood loss, for example, with the birth of the anterior shoulder, or very soon after the birth.

33. Manual removal of placenta • Whether the placenta was manually removed • this field should be left blank if method of delivery is via caesarean section.

34. Perineal laceration – degree/type • The degree or type of laceration to the perineum following birth • Now reported regardless whether the tear was sutured. • For episiotomies extended by laceration or laceration extended by episiotomy record yes in the following fields: • Laceration • Episiotomy • Repaired • Specify the degree of the tear in perineal laceration – degree/ type.

35. Perineal laceration – repair • Whether a repair to a laceration or incision to the perineum during birth was undertaken • record the suturing of any injury to the perineum. Include repair to perineal, vaginal, clitoral or vulval lacerations and/or episiotomy (or other perineal incision).

36. Estimated blood loss • An estimate of the amount of blood lost at the time of birth and in the following 24 hours in millilitres (whether the loss is from the vagina, from an abdominal incision, or retained, for example, broad ligament haematoma) • report the best estimate of the amount of blood lost in millilitres (mls). This is usually reported to the nearest 50 ml but may be more accurate than this if desired, for example, when there is very small amount of bleeding. • Fill with 9s if unknown.

37. Blood product transfusion - mother • Whether the mother was given a transfusion of whole blood or any blood product (excluding anti-D) during her postpartum stay.

38. Postpartum complications • This has been split from the previous ‘Complications of labour, birth or postnatal’ item. • Refers to postpartum complications arising after delivery up to the time of separation from care.

39. Baby UR number • An identifier, unique to the baby, within the hospital or campus (patient’s record number/unit record number). • This is an optional field, record if known.

40. Condition (birth status) • Condition of the baby at birth • Now collecting the following: • 1 Liveborn • 2 Stillborn (occurring before labour) • 3 Stillborn (occurring during labour)

41. Resuscitation method - mechanical • A new set of methods have been added: • 01 None • 02 Suction • 03 Oxygen therapy • 04 Intermittent Positive Pressure Respiration bag & mask with air • 14 Intermittent Positive Pressure Respiration bag & mask with oxygen • 05 Endotracheal intubation & IPPR with air • 15 Endotracheal intubation & IPPR with oxygen • 06 External cardiac massage & ventilation • 07 Continuous Positive Airway Pressure with air • 17 Continuous Positive Airway Pressure with oxygen • 88 Other • 99 Not stated / inadequately described

42. Resuscitation method - drugs • Drugs administered immediately after birth to establish independent respiration and heartbeat, or to treat depressed respiratory effort and to correct metabolic disturbances • 1 None (no drug therapy) • 2 Narcotic antagonist • 3 Sodium bicarbonate • 4 Adrenalin • 5 Volume expander • 8 Other drugs • 9 Not stated / inadequately described

43. Hepatitis B vaccine received • Whether the baby received an immunisation vaccine for hepatitis B during the birth admission, before or after seven days: • report the administration of a dose of paediatric hepatitis B vaccine. Do not report immunoglobulin.

44. Breastfeeding initiation • Whether the mother attempted to breastfeed the baby or express breastmilk at least once.

45. Formula in hospital • Whether any infant formula was given to this baby in hospital, whether by bottle, cup, gavage or other means.

46. Last feed before discharge • Whether the last feed prior to discharge was taken directly from the breast with no complementary feeding of any kind.

47. Why are the VPDCU collecting the new data items? • There is a demand from various sources including, DHS, researchers and health agencies, to have an understanding of the trends and outcomes in maternal and perinatal mortality and morbidity reporting. • Previously the focus has been on mortality; the current view is to concentrate more on morbidity. • National and internationally perinatal collection units are now capturing and reporting on more morbidity items • Some of the new items on the perinatal form include: BMI, smoking and baby’s indigenous status.

48. How will these new data items be used by the VPDCU? • To inform policy. • To inform the recommendations that come from the Consultative Council in Obstetric and Paediatric Mortality and Morbidity (COPPM). • To improve education, health resources, and assist in providing information for the planning of neonatal care units. • The User Guide is a working draft, feedback on any area of reporting would be appreciated. • The User Guide is available on the website for viewing and comment: www.health.vic.gov.au/perinatal/pubs/guide.

49. Revised perinatal data collection form – birth report

50. UserGuide Available on line at: www.health.vic.gov.au/perinatal/pubs/guide