National Perinatal Epidemiology Centre - Journal Articles
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Item Area-level deprivation as a risk factor for stillbirth in upper-middle and high-income countries: A scoping review(Elsevier B.V., 2025-12-06) Keane, Jessica V.; Robinson, Laura A.; Greene, Richard A.; Corcoran, Paul; Leitao, SaraBackground: Socioeconomic deprivation has been associated with health inequalities and poor perinatal outcomes. Deprivation is described as a multidimensional concept, with composite indicators (e.g. area-based) developed internationally to study population health. Aim: This scoping review aims to examine published literature on the relationship between area-level deprivation and stillbirth in upper-middle to high-income countries. Methods: The Joanna Briggs Institute methodology for scoping reviews was utilised. The research question based on the Population (studies that examined stillbirth) Concept (area-level deprivation and its impact on stillbirth) Context (upper-middle- to high-income countries) framework. Six scientific databases were searched. Results were screened and reference lists searched to identify relevant literature. Data extraction on study characteristics and evidence of association provided was completed and a narrative summary reported the main findings. Results: A total of 29 studies were included, from 9 countries (majority UK-based: n = 20) published between 1998 and 2023. A variety of composite deprivation indices were utilised, the UK's Index of Multiple Deprivation (IMD) was the most common (n = 8), followed by the Townsend and Jarman indices (n = 6 and n = 3, respectively). Income, employment, education and access to services were the most common factors included as measures of deprivation in the indices. Twenty-two of the 29 studies (75.9%) showed positive correlations between stillbirth and areas identified more socioeconomically deprived. Conclusion: This review suggests that area-level deprivation seems an influencing factor on stillbirth in upper-middle to high-income countries. Focused initiatives to reduce stillbirth among those at higher deprivation related risk may be useful in improving maternal and perinatal outcomes.Item Improving the quality of newborn feeding documentation in an EHR using a mixed methods approach(Elsevier Ltd., 2024-07-24) Sheehan, Orla Maria; Greene, Richard A.; Corcoran, Paul; McKernan, Joye; Murphy, BrendanIntroduction: Newborn feeding is key to infant growth and survival. Accurate feeding documentation can inform care decisions and planning of care. A nutritional dashboard is available within the Electronic Health Record (EHR) which accumulates feeding data in a graphical display. Purpose: To improve the quality of newborn feeding documentation for post-natal ward babies and babies in the Neonatal Intensive Care Unit (NICU). Design and Methods: A multidisciplinary end user expert group (n = 38) was established. Qualitative thematic analyses from this group were used to design new feeding data entry and review elements. Quantitative pre-post design was used to assess feeding documentation for both post-natal ward baby charts (n = 134) and NICU baby charts (n = 188). Descriptive statistics and Pearson's chi-square were used to assess pre-post differences and statistical significance. The use of a nutritional dashboard was assessed using system audit logs and analyzed using Poisson regression testing. Results: Post-natal ward babies had improvements in structured feeding documentation by 91.6% (from 17.9% to 34.3%) (p = 0.031). NICU data feeding documentation improved by 25% (from 72.3% to 90.4%) (p = 0.001). Use of the nutritional dashboard however reduced in the post period. Conclusion: This study has positively demonstrated improvements in the quality of newborn feeding documentation within the patient's EHR can be achieved through a collaborative multidisciplinary approach optimising EHR design. Practice implications: The benefit of a multidisciplinary approach to EHR design is paramount to promoting superior quality data entry compliant with individual workflows.Item Factors affecting third‐stage management and postpartum hemorrhage in planned midwife‐led home and birth center births in the United States(John Wiley & Sons, Inc., 2020-07-29) Erickson, Elise N.; Bovbjerg, Marit L.; Cheyney, Melissa J.; Foundation for the Advancement of Midwifery; National Institutes of Health; Eunice Kennedy Shriver National Institute of Child Health and Human Development; Fulbright Association; Health Resources and Services AdministrationBackground: Postpartum hemorrhage (PPH) is a potential childbirth complication. Little is known about how third-stage labor is managed by midwives in the United States, including use of uterotonic medication during community birth. Access to uterotonic medication may vary based on credentials of the midwife or state regulations governing midwifery. Methods: Using data from the Midwives of North America 2.0 database (2004-2009), we describe the PPH incidence for women giving birth in the community, their demographic and clinical characteristics, and methods used by midwives to address PPH. We also examined PPH rates by midwifery credentials and by the presence of regulations for legal midwifery practice. Results: Of the 17 836 vaginal births, 15.9% had blood loss of over 500 mL and 3.3% had 1000 mL or greater blood loss. Midwives used pharmaceuticals to prevent or treat postpartum bleeding in 6.3% and 13.9% of births, respectively, and the rate of hospital transfer after birth was 1.4% (n = 247). In adjusted analyses, PPH was less likely when births occurred at home vs a birth center, if the midwife had a CNM/CM credential vs a CPM/LM/LDM credential, or if the woman was multiparous without a history of PPH or prior cesarean birth. PPH was more likely in states with barriers to midwifery practice compared with regulated states (OR: 1.26; 95% CI, 1.16-1.38).Conclusions: Women giving birth in the community experienced low overall incidence of PPH-related hospital transfer. However, the occurrence of PPH itself would likely be reduced with improved legal access to uterotonic medication.Item Discharge age and weight for very preterm infants in six countries: 2012-2020(Karger International, 2023-01) Edwards, Erika M.; Greenberg, Lucy T.; Horbar, Jeffrey D.; Gagliardi, Luigi; Adams, Mark; Berger, Angelika; Leitao, Sara; Luyt, Karen; Ehret, Danielle E. Y.; Rogowski, Jeannette A.Postmenstrual age for surviving infants without congenital anomalies born at 24-29 weeks' gestational age from 2005 to 2018 in the USA increased 8 days, discharge weight increased 316 grams, and median discharge weight z-score increased 0.19 standard units. We asked whether increases were observed in other countries. We evaluated postmenstrual age, weight, and weight z-score at discharge of surviving infants without congenital anomalies born at 24-29 weeks' gestational age admitted to Vermont Oxford Network member hospitals in Austria, Ireland, Italy, Switzerland, the UK, and the USA from 2012 to 2020. After adjustment, the median postmenstrual age at discharge increased significantly in Austria (3.6 days, 99% CI [1.0, 6.3]), Italy (4.0 days [2.3, 5.6]), and the USA (5.4 days [5.0, 5.8]). Median discharge weight increased significantly in Austria (181 grams, 99% CI [95, 267]), Ireland (234 [143, 325]), Italy (133 [83, 182]), and the USA (207 [194, 220]). Median discharge weight z-score increased in Ireland (0.24 standard units, 99% CI [0.12, 0.36]) and the USA (0.15 [0.13, 0.16]). Discharge on human milk increased in Italy, Switzerland, and the UK, while going home on cardiorespiratory monitors decreased in Austria, Ireland, and USA and going home on oxygen decreased in Ireland. In this international cohort of neonatal intensive care units, postmenstrual discharge age and weight increased in some, but not all, countries. Processes of care at discharge did not change in conjunction with age and weight increases.Item Predicting risk of postpartum haemorrhage during the intrapartum period in a general obstetric population(Elsevier B. V., 2022-09) Maher, Gillian M.; McKernan, Joye; O'Byrne, Laura; Corcoran, Paul; Greene, Richard A.; Khashan, Ali S.; McCarthy, Fergus P.; Health Research BoardObjective: To develop and validate (both internally and externally) a prediction model examining a combination of risk factors in order to predict postpartum haemorrhage (PPH) in a general obstetric Irish population of singleton pregnancies. Study design: We used data from the National Maternal and Newborn Clinical Management System (MN-CMS), including all singleton deliveries at Cork University Maternity Hospital (CUMH), Ireland during 2019. We defined PPH as an estimated blood loss of = 1000 ml following the birth of the baby. Multivariable logistic regression with backward stepwise selection was used to develop the prediction model. Candidate predictors included maternal age, maternal body mass index, parity, previous caesarean section, assisted fertility, gestational age, fetal macrosomia, mode of delivery and history of PPH. Discrimination was assessed using the area under the receiver operating characteristic curve (ROC) C-statistic. We used bootstrapping for internal validation to assess overfitting, and conducted a temporal external validation using data from all singleton deliveries at CUMH during 2020. Results: Out of 6,077 women, 5,807 with complete data were included in the analyses, and there were 270 (4.65%) cases of PPH. Four variables were considered the best combined predictors of PPH, including parity (specifically nulliparous), macrosomia, mode of delivery (specifically operative vaginal delivery, emergency caesarean section and prelabour caesarean section), and history of PPH. These predictors were used to develop a nomogram to provide individualised risk assessment for PPH. The original apparent C-statistic was 0.751 (95% CI: 0.721, 0.779) suggesting good discriminative performance. There was minimal optimism adjustment to the C-statistic after bootstrapping, indicating good internal performance (optimism adjusted C-statistic: 0.748). Results of external validation were comparable with the development model suggesting good reproducibility. Conclusions: Four routinely collected variables (parity, fetal macrosomia, mode of delivery and history of PPH) were identified when predicting PPH in a general obstetric Irish population of singleton pregnancies. Use of our nomogram could potentially assist with individualised risk assessment of PPH and inform clinical decision-making allowing those at highest risk of PPH be actively managed.