Queensland
David Ellwood: Co-Lead
Chris Lehner: Co-Lead
David Watson: Co-Lead
-
There are just over 60,000 births a year in Queensland and the most recent data show that 9.3% are born preterm. This number is above the national figure of 8.5% and there has been a steady rise with a 6% increase in rate between 2011 and 2016.
-
The exact reasons for this are unclear and need further investigation three areas stand out as ripe for intervention
Firstly, there has been a shift towards earlier term birth and an increase in late preterm birth. These are elective early births, and in many cases are based on reasonable clinical decisions. But nationally and internationally there has been a reduction in the threshold for deciding to deliver early and this is certainly being seen in Queensland. This is likely to be the largest group of avoidable preterm births.
Secondly, there are risk factors for preterm birth which are highly prevalent in parts of the state. Cigarette smoking in pregnancy is high in far north Queensland and in some parts of metropolitan Brisbane. Targeted interventions to improve smoking cessation rates in these areas will reduce preterm births.
Finally, the use of ultrasound screening of cervical length is used inconsistently across Queensland, even though there is a strong evidence-base for screening and treatment of the short cervix with progesterone.
The exact reasons for the rise in preterm births remains unclear and need further investigation. However, three areas stand out and are currently a major focus of education and research.
Firstly, there has been a shift towards earlier term birth and an increase in late preterm birth. These are elective early births, and in many cases are based on reasonable clinical decisions. But nationally and internationally there has been a reduction in the threshold for deciding to deliver early and this is certainly being seen in Queensland. This is likely to be the largest group of avoidable preterm births. In order to avoid elective late preterm and early term birth, and stress the importance of prolonging pregnancy if clinically feasible, education in various Queensland Health facilities commenced in June 2019 and will be rolled out further across the state later in the year.
Secondly, there are risk factors for preterm birth, which are highly prevalent in parts of the state. Cigarette smoking in pregnancy is high in far north Queensland and in some parts of metropolitan Brisbane. Targeted interventions to improve smoking cessation rates in these areas will reduce preterm births. Education focuses on primary health care providers and both obstetric medical and midwifery staff to stress the importance of Quitline support and appropriate referral for smoking cessation, ideally preconception or as early as possible in pregnancy.
Finally, the use of ultrasound screening of cervical length is used inconsistently across Queensland, even though there is a strong evidence-base for screening and treatment of the short cervix with progesterone at routine midtrimester fetal morphology assessment. In some areas there is access to high quality ultrasound and cervical screening is widely practised. In other areas, especially rural and remote Queensland, its use is much less. Therefore our Queensland initiative aims for universal cervical screening between 18 and 20 weeks gestation accessable to all women across the state regardless of primary residence and region of origin. Education will target obstetric staff, sonographers and radiologists with a suggested protocol on routine cervical screening and referral criteria for urgent obstetric review if applicable.
Even if the only achievement was to reduce the recent 6% increase back to the levels seen over 10 years ago this would mean 360 fewer preterm babies admitted to Queensland nurseries. Further gains could increase this number and reducing preterm births by over 500 should be a realistic goal. In order to achieve this, implementation of evidence-based key interventions are promoted widely across the state and we are also exploring potential new avenues to make a decrease in early birth a reality. Current research in Queensland examines the role of continuity of care models in preterm birth prevention. There is high quality evidence suggesting a 24 % reduction in preterm birth in midwifery continuity of care models compared to other models of care.
We hope that we can lower the rate of preterm birth in Queensland by continuous education of all maternity care providers, and continuous research in this field.
-
- David Ellwood: Co-Lead
- Chris Lehner: Co-Lead
- David Watson: Co-Lead