Tasmania

From 2014 to 2018, prior to involvement in the Australian Preterm Birth Prevention Alliance, Tasmania had the highest preterm birth rate in the country, at around 11%. Following a dedicated education campaign across the state and implementation of the key strategies to prevent preterm birth (largely routine measurement of the cervix at the mid-trimester anatomy scan and avoidance of late preterm birth in the absence of a strong medical or obstetric indication), the rate of preterm birth in public hospitals across the state fell by 19.8%, from 9.1% in 2017 to 7.3% in 2020.

Through our involvement in the ‘Every Week Counts National Collaborative’ the Royal Hobart Hospital maintained this lower rate of preterm birth of 7%. We were proud to bring Mikaela into our multidisciplinary team, as a consumer with lived experience, to share the story of her first birth at 24 weeks, and her second pregnancy at 37 weeks. We ran a number of education sessions around the state, and Mikaela was an important part these events, providing s personal touch to deliver our message on the important work we were doing. We also focussed our efforts on reducing the percentage of early term births without a clear obstetric or medical indication by increasing our number of elective caesarean section lists and restructuring our Obstetric Endocrine clinic, as these were two key ares we identified that would have a big impact.

In Tasmania, we have a high number of births to young mothers (under the age of 20), a high proportion of women who continue to smoke through their pregnancy, and a high number of women living in larger bodies (compared with the national average). Although we are a small state, with one public health service and as such we can share a lot of resources with our colleagues in the north and the north west, many of the women and families we care for are from socially disadvantaged areas, and all of these factors can have an impact on the chance of pregnancy complications, including preterm birth.

The team at the RHH are excited to again be a part of phase two of the Every Week Counts National Collaborative. We are focussing our efforts this time on preeclampsia screening within the antenatal clinic, ensuring our data is captured accurately, and paying special attention to the care of our First Nations women. Representatives from our team are looking forward to sharing ideas and working with others at the first Learning Session of the Collaborative in Brisbane in May.

Preterm preeclampsia screening is offered at the one dedicated private women’s ultrasound provider in Hobart, but most of the providers of the nuchal translucency ultrasound perform uterine artery Dopplers. A large percentage of women receiving maternity care through the public health system also have first trimester biochemistry. We currently screen for preterm preeclampsia based on maternal demographics, though we are likely missing an opportunity to provide a more accurate risk assessment with the information we already have, and so we want to see how easy it will be to incorporate this into routine practice using the FMF preeclampsia risk calculator.

Previously, as part of our education campaigns, we have visited private ultrasound practices. These education sessions have been well received and have strengthened our working relationships. In this phase of the Collaborative, we hope to engage primary health care providers, and also reach out to our colleagues, both midwifery and medical, in private.

• Dr Lindsay Edwards – Lead, Obstetrician and Maternal Fetal Medicine Specialist
• Becky French, Assistant Midwifery Director, Executive Sponsor
• Kristy Newett, Midwifery Unit Manager
• Grace Ridler, Clinical Midwifery Consultant
• Peggy Tsang, Data manager Department of Health
• Mikaela Dunn, consumer with lived experience

Several studies are underway looking at risk factors for preterm birth across the state and reasons as to why the preterm birth rate has changed so dramatically over the past 10-15 years. Watch this space for future publications.