Dr Euan Wallace, Director, Monash University -
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Transcript of Dr Euan Wallace, Director, Monash University -
Race-based Care:
is that good medicine?
Professor Euan M Wallace
The Ritchie Centre, Monash Institute of Medical Research
Department of Obstetrics and Gynaecology, Monash University
Monash Women’s Services, Monash Health
the RITCHIE CENTRE
the RITCHIE CENTRE
What defines a good pregnancy outcome?
a satisfied mother
the RITCHIE CENTRE
What defines a good pregnancy outcome?
- normal vaginal birth
- intact perineum
- successful breastfeeding
- healthy baby
- no postnatal depression
- no “other” complication (bleeding, infection)
the RITCHIE CENTRE
no mention of race or ethnicity
the RITCHIE CENTRE
75% Australian born mothers
the RITCHIE CENTRE
40% Australian born mothers
the RITCHIE CENTRE
Is ethnicity associated with pregnancy outcome?
- normal vaginal birth
- intact perineum
- successful breastfeeding
- healthy baby
- no postnatal depression
- no “other” complication (bleeding, infection)
What defines a good pregnancy outcome?
the RITCHIE CENTRE
Is ethnicity associated with pregnancy outcome?
- normal vaginal birth
- intact perineum
- successful breastfeeding
- healthy baby
- no postnatal depression
- no “other” complication (bleeding, infection)
the RITCHIE CENTRE
Monash Medical Centre level 6 maternity unit
3800 births pa
Dandenong Hospital level 5 maternity unit
2500 births pa
Casey Hospital level 4 maternity unit
1500 births pa
the RITCHIE CENTRE
ns
p<0.01
p<0.01
Mode of birth, by maternal region of birth N
o (
%)
wo
me
n
the RITCHIE CENTRE
South Asian women are twice as likely as Australian-born
women to have an emergency intrapartum caesarean section
the RITCHIE CENTRE
ns
P<0.01
Pregnancy & birth outcomes, by maternal region of birth
ns
ns P<0.05
P<0.05
No
(%
) w
om
en
the RITCHIE CENTRE
South East/East Asian women are almost half as likely as
Australian-born women to have an intact perineum following
vaginal birth
South Asian women are twice as likely as Australian-born
women to have severe perineal trauma
Odds ratio (95%CI) of stillbirth ≥ 37 weeks 1.0 2.4 (1.4-4.0) 0.7 (0.4-1.2) <0.0001
= RR for >41 wks
the RITCHIE CENTRE
customized fetal growth charts
Customized growth charts will likely increase the stillbirth rate, not reduce it
Customised charts assumes that variations in birthweight related to maternal
characteristics are physiological and not associated with pathological (adverse)
outcomes.
Inclusion of maternal characteristics that have a pathological (adverse) influence on
growth would inappropriately normalise SGA in an infant at increased risk of
stillbirth (ie “hide” the at risk fetus)
So, do customised growth charts normalise (hide) the at risk SGA fetus?
1. Infants of small mothers are more likely to be SGA than larger mothers
2. SGA infants of small mothers are at higher risk of stillbirth than AGA infants
Customized defined SGA
Population defined SGA NNM hazard ratio vs whites: 2.10
Revealed SGA hazard ratio vs whites: 2.16
Revealed SGA hazard ratio vs whites: 1.10
the RITCHIE CENTRE
Pregnancy outcomes differ by maternal ethnicity?
- need for post-term induction
- risk of intrapartum fetal compromise
- rate of intact perineum
- rate of severe perineal trauma
- rate of growth restriction
- rate of late pregnancy stillbirth
the challenge is to identify mechanisms and tailor care accordingly
the RITCHIE CENTRE
the RITCHIE CENTRE
Acknowledgements
Monash Health Michelle Knight
Amanda Knight
The Ritchie Centre Miranda Davies-Tuck
Henry Drysdale
Monash University Mary Anne Biro
Christine East