National Women's Annual Clinical Report 2010

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5.4 Diabetes Methods The data in this section relate to women with a diagnosis of pre-existing or gestational diabetes who birthed at National Women’s in 2010. It includes women who were cared for solely by the National Women’s Diabetes Clinic, women with some input from the Diabetes Clinic while under the care of non-Diabetes Clinic LMC, and women with no Diabetes Clinic input. It does not include women cared for by the Diabetes Clinic who birthed prior to 20 weeks or who birthed elsewhere. Findings In addition to these data the diabetes service had 56 referrals for pre-pregnancy counselling. We saw 38 of the pre-pregnancy referrals, but 18 remain unseen because we have not had the capacity to review them. Also 30 other women were booked into clinic but their data are not shown as they either miscarried or transferred elsewhere for birthing. The ongoing rise in women with GDM probably reflects an increased uptake of testing for GDM plus the change in population demographics with increased rates of obesity and type 2 diabetes at younger ages. Last year we commented that new international guidelines for testing for diabetes in pregnancy had been published, which would lead to more women being diagnosed with GDM, as the recommendations had a lower glucose cut off for the diagnosis of GDM than current NZ criteria. In Auckland, we have not changed to the new criteria, as we are struggling to provide adequate care for women who are diagnosed by our current criteria. We have continued to work on developing models of care so that some women can be cared for in community clinics in the future. Education and training of clinicians to provide this care is a priority. Hopefully, we can then have discussions about whether to adopt the new criteria over the next 12 months. GDM 8.0 7.0 6.0 5.0 4.0 3.0 2.0 1.0 0.0 GDM Type I Type 2 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Figure 25: Incidence of diabetes (% of all inborn and BBA births) (1991-2010) 56 2.0 1.8 1.6 1.4 1.2 1.0 0.8 0.6 0.4 0.2 0.0 Type 1 and 2
5.4.1 Demographic characteristics of women with diabetes It can be seen that the non-European ethnicities have the highest rates of GDM. We would expect our Polynesian women to have the highest rates of GDM overall, as they have the highest rates of type 2 diabetes. It is not clear whether Polynesian women are less likely to perform testing for GDM or whether they have more false negative results. We want to look at this issue in more detail. 18 16 14 12 10 8 6 4 2 0 % NZ European Type 1 Type 2 GDM Maori Pacific Other Asian Indian Other European Figure 26: Incidence of diabetes by ethnic group (2010) 5.4.2 Outcomes of pregnancies complicated by diabetes Maternal outcomes Other Mode of birth is stable and the Caesarean section rate has not significantly increased over the past ten years. % Spontaneous vaginal birth Operative vaginal birth 60 Caesarean section 50 40 30 20 10 0 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Figure 27: Mode of birth among women with GDM (1999-2010) 57
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National Women’s Annual Clinical
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It is my pleasure to present the 20
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7 LABOUR AND BIRTH OUTCOMES .......
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Table 50: Neonatal outcomes followi
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Table 153: Preterm birth and matern
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Table 258: Perinatal mortality rate
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Figure 53: Mode of birth (1991-2010
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Chapter 1 INTRODUCTION 1
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Chapter 8: Postnatal care This chap
Page 20 and 21: 1.5.3 Gynaecologic data quality As
Page 23 and 24: 2 SERVICE PROVISION 2.1 Maternity s
Page 25 and 26: 2.2.4 Antenatal and Postnatal Wards
Page 27 and 28: The service has access to the ACH L
Page 29 and 30: 2.5.3 University Links There are cl
Page 31 and 32: Reportable events All incidents (mi
Page 33: Chaptern 3 SUMMARY STATISTICS 19
Page 36 and 37: 3.2 Summary of maternal outcomes 20
Page 38 and 39: Rate Table 7: Perinatal related mor
Page 40 and 41: Maternal indicator Caesarean sectio
Page 42 and 43: 50 45 40 35 30 25 20 15 10 5 0 % Ep
Page 45 and 46: 4 MATERNAL DEMOGRAPHY This chapter
Page 47 and 48: 4.2.2 Maternal ethnicity When more
Page 49 and 50: % 60 50 40 30 20 10 0 NZ European M
Page 51 and 52: 4.5 Body mass index Thirty five per
Page 53 and 54: % 100 80 60 40 20 0 European Maori
Page 55: Women booked with a private obstetr
Page 59 and 60: 5 ANTENATAL COMPLICATIONS This chap
Page 61 and 62: Ethnic differences in rates of pret
Page 63 and 64: of women under 20 with SGA babies s
Page 65 and 66: Perinatal deaths in term SGA infant
Page 67 and 68: The rate of multiple pregnancy rema
Page 69: Summary / Implications Multiple pre
Page 73 and 74: 5.4.5 Perinatal losses Diabetes Per
Page 75 and 76: A confirmed placental abruption is
Page 77 and 78: 70 60 50 40 30 20 10 0 % Gestationa
Page 79 and 80: 5.7 Body Mass Index Methods BMI is
Page 81 and 82: % European Maori Pacific Other Asia
Page 83 and 84: 50 45 40 35 30 25 20 15 10 5 0 % Eu
Page 85 and 86: 16 % 40 14 12 10 8 6 4 2 0 Iatrogen
Page 87: Table 38: Mothers with babies diagn
Page 91 and 92: 6 LABOUR AND BIRTH This chapter inc
Page 93 and 94: Table 39: Maternal demographic char
Page 95 and 96: Table 40: Gestation at birth among
Page 97 and 98: Women given syntocinon prior to 3 c
Page 99 and 100: 70 60 50 40 30 20 10 0 % NZ Europea
Page 101 and 102: 6.5 Caesarean section WHA Maternity
Page 103 and 104: Caesarean section rate 60 50 40 30
Page 105 and 106: Sixty percent of para 1 women with
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Page 115 and 116: Table 58: Interventions and outcome
Page 117 and 118: Chaptern 7 LABOUR and BIRTH OUTCOME
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7.2 Third stage management Methods:
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Table 61: Postpartum haemorrhage ra
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7.4 Emergency peripartum hysterecto
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Chaptern 8 POSTNATAL CARE 113
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8 POSTNATAL CARE This chapter provi
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% 90 85 80 75 70 65 60 55 50 45 40
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8.2 Postnatal admissions Methods Pr
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Table 70: Reason for admission to N
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Chaptern 9 NEWBORN SERVICES 123
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9 NEWBORN SERVICES This chapter pro
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9.2 NICU occupancy For 2010 the ver
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Number 700 600 500 400 300 200 100
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9.3.4 Reasons for admission to NICU
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9.4.3 Intraventricular haemorrhage
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246 for 2010. This number is higher
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9.4.8 Trends in the use of assisted
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9.4.10 Positive pressure ventilatio
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9.4.12 Term/post-term infants on as
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9.5.2 Survival of inborn babies (23
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20% 18% 16% 14% 12% 10% 8% 6% 4% AN
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9.5.10 Postnatal corticosteroids (A
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express milk for many weeks before
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9.9 Child Development Unit 9.9.1 Fo
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9.9.2 Development at 4 years of chi
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Chapter 10 PERINATAL MORTALITY 155
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10 PERINATAL MORTALITY This chapter
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Table 87: Perinatal related loss an
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10.5 Causes of perinatal-related de
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Chapter 11 SEVERE MATERNAL MORBIDIT
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11 SEVERE MATERNAL MORBIDITY This c
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Chapter 12 GYNAECOLOGY 167
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12 GYNAECOLOGY This chapter provide
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12.2 Termination of pregnancy Epsom
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12.3 Second trimester Termination o
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12.4 Gynaecology inpatient surgery
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Table 101: Demographic details of w
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ACHS Gynaecology Indicators: Injury
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12.5 Gynaecologic laparoscopic proc
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12.6 Hysterectomy Methods See Gynae
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% 80 70 60 50 40 30 20 10 0 Abdomin
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12.7 Urogynaecology Methods As in p
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Table 113: Complications of surgery
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12.8 Colposcopy Methods: The data p
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Referral smear cytology Table 117:
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The number of treatments and percen
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Number of patients 4.5 4 3.5 3 2.5
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12.9 Gynaecologic oncology surgical
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11.9.2 Gynaecologic oncology surger
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203
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Antenatal Summary screen; Reason fo
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Postnatal Mothers Destination to Wa
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APPENDIX 2. SUMMARY STATISTICS Tabl
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Table 135: Time trends in nullipari
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Table 141: Rates of smoking at book
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Table 149: LMC at birth and materna
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APPENDIX 4. ANTENATAL COMPLICATIONS
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Table 157: Demographic characterist
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4.4 Hypertensive disease Table 160:
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Table 164: LMC at birth and BMI (20
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APPENDIX 5. LABOUR AND BIRTH 5.1 In
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5.2 Outcomes following induction Ta
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Table 180: Mode of birth by LMC at
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5.5 Operative births Table 189: Pri
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Table 196: Referral for ECV (women
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APPENDIX 6. LABOUR and BIRTH OUTCOM
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APPENDIX 7. POSTNATAL CARE 7.1 Infa
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Table 213: Maternal destination fol
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Table 220: Admissions of inborn bab
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Table 224: Admissions of outborn ba
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8.2.5 Antenatal corticosteroids Tab
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8.3.2 Intraventricular haemorrhage
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8.4.1 Survival Table 240: Numbers o
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8.5.4 Patent Ductus Arteriosus Tabl
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Table 252: Inborn babies receiving
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APPENDIX 9. PERINATAL MORTALITY Tab
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Table 260: Cause of perinatal-relat
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10.2 Gynaecology Inpatient Surgery
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APPENDIX 11. GLOSSARY OF ABBREVIATI
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APPENDIX 12. DEFINITIONS Antepartum
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Lead Maternity Carer (LMC) The Lead
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Standard primipara A woman with no
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National Women's Annual Clinical Report 2010

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