National Women's Annual Clinical Report 2010

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5.6 Hypertensive disease Methods The following definitions of hypertension in pregnancy have been used in this report: Gestational hypertension: Gestational hypertension (GH) is a blood pressure systolic ≥140 and / or diastolic ≥ 90 mmHg on two or more consecutive occasions at least 4 hours apart or one measurement systolic BP ≥170 and or diastolic BP ≥110 mmHg. Preeclampsia: Gestational hypertension accompanied by proteinuria measured as ≥2+ protein on one dipstick sample or Protein Creatinine Ratio (PCR) ≥30 on a spot urine sample, or a 24 hour collection ≥0.3g in 24 hours. Chronic hypertension: diastolic BP >90mmHg at booking or a medical history of essential hypertension. Includes women with superimposed pre-eclampsia if these are not categorised separately. Super imposed preeclampsia: The development of preeclampsia in a patient with chronic hypertension. The cleaning of hypertension data involves reconciling data from booking history, indication for induction and operative birth, reason for admission to the ward or to High Dependency Unit, data collected at birth and coded data from the Decision Support Unit. Findings The overall rate of hypertensive disease in pregnancy (8.5%) is similar to the rate in 2009. It still remains a very common medical disorder in pregnancy. Chronic hypertension is more common in the multiparous population, with gestational hypertension and preeclampsia being predominant in nulliparous women. Women with increased BMI had higher rates of hypertensive disease in pregnancy, especially if their BMI was greater than 40. Thirty-five percent of women with a BMI over 45 had hypertensive disease in pregnancy. There was 1 reported case of eclampsia in <strong>2010</strong> (0.2% of hypertensive pregnancies) and this occurred postpartum. Table 33: Hypertensive disease in pregnancy (<strong>2010</strong>) All women Nullipara Multipara N=7709 n=3650 n=4059 n % n % n % Any hypertensive disease 653 8.5 362 9.9 291 7.2 Gestational hypertension 234 3.0 145 4.0 89 2.2 Chronic hypertension 164 2.1 56 1.5 108 2.7 Chronic hypertension superimposed preeclampsia with 24 0.3 8 0.2 16 0.4 Preeclampsia 231 3.0 153 4.2 78 1.9 Eclampsia 1 0.01 0 1 0.02 Hypertensive disease is associated with an increase in interventions to interrupt pregnancy. Fifty six percent of normotensive women went into labour spontaneously, compared with only 26%, 13% and 31% of the women with gestational hypertension, preeclampsia or chronic hypertension respectively. A diagnosis of preeclampsia, chronic hypertension or superimposed preeclampsia is associated with a high risk of Caesarean section birth (57%, 36% and 63% respectively). 62
70 60 50 40 30 20 10 0 % Gestational hypertension Spont onset of labour Induced labour CS emergency before labour CS elective Chronic hypertension Superimposed preeclampsia Preeclampsia Normotensive Figure 28: Onset of birth and hypertensive disorders of pregnancy Table 34: Mode of birth for women with hypertensive disease Gestational hypertension n=234 Chronic hypertension n=164 Superimposed preeclampsia n=24 Preeclampsia n=231 Normotensive n=7056 n % n % n % n % n % Mode of birth Normal vaginal 120 51.3 85 51.8 6 25.0 69 29.9 3996 56.6 Operative vaginal 40 17.1 20 12.2 3 12.5 31 13.4 848 12.0 CS elective 22 9.4 31 18.9 4 16.7 28 12.1 1137 16.1 CS emergency 52 22.2 28 17.1 11 45.8 103 44.6 1075 15.2 Epidural 166 70.9 110 67.1 20 83.3 186 80.5 4173 59.1 General Anaesthetic 15 6.4 4 2.4 0 0.0 15 6.5 200 2.8 Table 35: Perinatal outcomes and hypertensive complications of pregnancy (n=babies) Gestational hypertension n= 237 Chronic hypertension n=167 Superimposed preeclampsia n=24 Preeclampsia n=248 Normotensive n=7190 n % n % n % n % n % Gestation at birth
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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
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1.5.3 Gynaecologic data quality As
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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 and 70: Summary / Implications Multiple pre
Page 71 and 72: 5.4.1 Demographic characteristics o
Page 73 and 74: 5.4.5 Perinatal losses Diabetes Per
Page 75: A confirmed placental abruption is
Page 79 and 80: 5.7 Body Mass Index Methods BMI is
Page 81 and 82: % European Maori Pacific Other Asia
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Page 85 and 86: 16 % 40 14 12 10 8 6 4 2 0 Iatrogen
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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
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Page 105 and 106: Sixty percent of para 1 women with
Page 107 and 108: 6.6 Instrumental vaginal birth WHA
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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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Page 121 and 122: 7.2 Third stage management Methods:
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Page 125 and 126: 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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