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Race-based Care:
is that good medicine?
Professor Euan M Wallace
The Ritchie Centre, Monash Institute of Medical Research
...
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 breastfeed...
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 b...
the RITCHIE CENTRE
Is ethnicity associated with pregnancy outcome?
- normal vaginal birth
- intact perineum
- successful b...
the RITCHIE CENTRE
Monash Medical Centre
level 6 maternity unit
3800 births pa
Dandenong Hospital
level 5 maternity unit
2...
the RITCHIE CENTRE
ns
p<0.01
p<0.01
Mode of birth, by maternal region of birth
No(%)women
the RITCHIE CENTRE
South Asian women are twice as likely as Australian-born
women to have an emergency intrapartum caesare...
the RITCHIE CENTRE
ns
P<0.01
Pregnancy & birth outcomes, by maternal region of birth
ns
ns P<0.05
P<0.05
No(%)women
the RITCHIE CENTRE
South East/East Asian women are almost half as likely as
Australian-born women to have an intact perine...
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...
1. Infants of small mothers are more likely to be SGA than larger mothers
2. SGA infants of small mothers are at higher ri...
Customized defined SGA
Population defined SGANNM hazard ratio vs whites: 2.10
Revealed SGA hazard ratio vs whites: 2.16
Re...
the RITCHIE CENTRE
Pregnancy outcomes differ by maternal ethnicity?
- need for post-term induction
- risk of intrapartum f...
the RITCHIE CENTRE
the RITCHIE CENTRE
Acknowledgements
Monash Health
Michelle Knight
Amanda Knight
The Ritchie Centre
Miranda Davies-Tuck
Hen...
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Dr Euan Wallace, Director, Monash University -

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Dr Euan Wallace, Director, The Ritchie Centre, Monash University delivered this presentation at the 2013 Obstetric Malpractice Conference. This is the only national conference for the prevention, management and defence of obstetric negligence claims.

For more information, go to http://www.healthcareconferences.com.au/obstetric13

Published in: Health & Medicine
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Transcript of "Dr Euan Wallace, Director, Monash University - "

  1. 1. 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
  2. 2. the RITCHIE CENTRE What defines a good pregnancy outcome? a satisfied mother
  3. 3. 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)
  4. 4. the RITCHIE CENTRE no mention of race or ethnicity
  5. 5. the RITCHIE CENTRE 75% Australian born mothers
  6. 6. the RITCHIE CENTRE 40% Australian born mothers
  7. 7. 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?
  8. 8. 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)
  9. 9. 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
  10. 10. the RITCHIE CENTRE ns p<0.01 p<0.01 Mode of birth, by maternal region of birth No(%)women
  11. 11. the RITCHIE CENTRE South Asian women are twice as likely as Australian-born women to have an emergency intrapartum caesarean section
  12. 12. the RITCHIE CENTRE ns P<0.01 Pregnancy & birth outcomes, by maternal region of birth ns ns P<0.05 P<0.05 No(%)women
  13. 13. 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
  14. 14. 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
  15. 15. the RITCHIE CENTRE customized fetal growth charts
  16. 16. 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?
  17. 17. 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
  18. 18. Customized defined SGA Population defined SGANNM hazard ratio vs whites: 2.10 Revealed SGA hazard ratio vs whites: 2.16 Revealed SGA hazard ratio vs whites: 1.10
  19. 19. 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
  20. 20. the RITCHIE CENTRE
  21. 21. 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
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