Background Women with rheumatic heart disease (RHD) can have a lower cardiac reserve to cope with pregnancy and labour, leading to increased obstetric and cardiac risks. The Northern Territory has been repeatedly reported to have the highest prevalence of RHD in Australia, yet evidence specific to pregnancy is scarce in the literature. Aims The primary aim of this paper is to describe the baseline characteristics and maternal outcomes of pregnant women with RHD presenting to the largest obstetrics referral hospital in the Northern Territory. The secondary aim is to evaluate the current model of care in relation to their cardiac status. Methods A retrospective observational study was conducted over a 9.5‐year period. Demographics, cardiac, obstetrics and anaesthetics data were collected for analysis. Results One hundred and twenty‐nine pregnancies were included for analysis. All women were identified as Aboriginal or Torres Strait Islander, and 85% were of a RHD priority of 2 or 3. Of all 28 patients who had an emergency caesarean section, only one patient was indicated for cardiac reasons. There was no maternal or neonatal death reported. Three preterm births were induced secondary to maternal concerns related to RHD cardiac decompensation. There were no major adverse neonatal outcomes, including neonatal death, intraventricular haemorrhage or respiratory distress syndrome. Multidisciplinary care was also evaluated. Conclusion We observed a low rate of maternal and fetal morbidity and no mortality in a cohort of women with mild to severe RHD. These favourable outcomes have occurred in a multidisciplinary centre with significant experience in managing the medical and cultural complexities of this group.
BackgroundReducing rates of preterm birth (PTB) remains a significant challenge. The Northern Territory (NT) records some of the highest rates of PTB in the country, especially in First Nations women. In 2014, a Western Australian (WA) preterm birth prevention initiative involved the implementation of seven key initiatives. One of these was routine mid‐trimester cervical length measurement. The initiative successfully reduced PTB rates following its first year of implementation. This was the first successful reduction in PTB, including the earlier gestational ages, across a population.AimsTo assess the uptake of routine cervical length measurement in the Top End of the NT after the success of the WA PTB prevention initiative and assess if treatment of a short cervix improved PTB rates.MethodsA retrospective cohort study of all women who received antenatal care and delivered their baby at the NT's only tertiary hospital was performed. Mid‐trimester ultrasound scan data were collected from two separate time windows, before and after the implementation of the WA intervention. Treatments and gestational age at birth were recorded.ResultsAdoption of routine screening of cervical length measurement at mid‐trimester ultrasound in the NT was successful, increasing from 4 to 88%. Detection rates of short cervix doubled. However, there was no difference to PTB rates despite targeted management.ConclusionPTB remains a significant challenge in the NT, especially for First Nations women who are found to have a short cervix more commonly than non‐Indigenous women in the Top End.
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