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Are you switched on?
Perinatal Data Collection
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Education session
Presenters name
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Agenda

• Overview of current landscape
• Revised data set
• new data items
• user manual
• Electronic or paper what are we doing from 1
  January 2009?
• Trial of electronic transmission

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Current landscape
Victorian Perinatal Data Collection Unit (VPDCU)
is authorised to collect information on every
birth in Victoria over 20 weeks gestation or
more than 400gms birth weight.

• Review of data elements has been in progress
  since 2006
• national data reporting requirements
• capture mortality information.
• Data is collected, analysed and reported annually
  for a calendar year.

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A revised perinatal data collection will be
implemented as of 1 January 2009.


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New data items

• What are the new or modified data items?
• Why are the VPDCU collecting them?
• How will they be used by the VPDCU?

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Setting of birth intended and actual

• The intended place of birth at the time of
  booking
• the name of the hospital where the birth was
  intended to take place is now required.
• The actual place where the birth occurred
• the name of the hospital where the birth occurred
  is now required.

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Setting of birth change of intent reason

• Reason for change of intent between where the
  mother intended to give birth and where the
  actual birth took place
• 1 Recognition of higher risk
• 2 Actual complication of pregnancy
• 3 Social or geographic e.g. moved house,
  preference
• 4 Unintended/unplanned
• 8 Other
• 9 Not stated / inadequately described.

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Maternal smoking lt 20 wks

• Cigarette smoking before 20 weeks gestation
• 1 No smoking at all before 20 weeks of pregnancy
• 2 Quit smoking during pregnancy (before 20 weeks)
• 3 Continued smoking before 20 weeks of pregnancy
• 9 Not stated / inadequately described.

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Maternal smoking gt 20 wks

• Cigarette smoking at 20 or more weeks gestation
• 00 No smoking at 20 or more weeks gestation.
• NN Average number of cigarettes smoked per day at
  20 or more weeks of pregnancy
• 98 Occasional smoking (less than one)
• 99 Not stated / inadequately described.

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Indigenous status - baby

• Indigenous status is a measure of whether a
  person (baby) identifies as being of Aboriginal
  or Torres Strait Islander origin and is accepted
  as such by the community in which they live.

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Height and weight

• A person's self-reported height, measured in
  centimetres at around the time of conception
• Valid range 100-250
• 999 (not stated).
• Mothers self-reported weight (body mass) around
  the time of conception
• Valid range 20-300
• 888 (unknown)
• 999 (not stated).

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Gravidity

• The total number of pregnancies, including the
  current one
• record the numbers of known pregnancies
  regardless of the gestation and outcome
• pregnancies of multiple fetuses should be counted
  as only one pregnancy. For example, a twin
  pregnancy is counted as one pregnancy, even
  though it has two outcomes.

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Parity

• The total number of previous pregnancies
  resulting in births at 20 or more weeks.
• Record the number of known previous pregnancies
  that ended in births at 20 or more weeks
  gestation, that is, count all pregnancies that
  result in livebirths - survived 28 days,
  livebirths-neonatal death, and stillbirths.
• Exclude the current pregnancy.
• If this is the first pregnancy, record 00.
• Pregnancies of multiple fetuses should be counted
  as only one pregnancy. For example, a twin
  pregnancy is counted as 1 pregnancy, even
  though it has two outcomes.

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Plan for VBAC

• Whether, at the time of admission to hospital for
  the birth, the woman hoped to have a vaginal
  birth after one or more previous caesarean
  sections
• only reported when total number of previous
  caesareans is greater than zero.

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Estimated date of confinement / agreed due date

• The agreed estimated date of confinement / due
  date.
• The estimated date of confinement may be based on
  the date of the last normal menstrual period
  (LNMP) or on clinical or ultrasound assessments.
• If there is uncertainty in each of these report
  the agreed due date based on the best available
  information in the particular case.
• Fill with 9s if unknown.

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Gestational age at 1st antenatal visit

• The number of completed weeks gestation at the
  time of the first antenatal visit (excluding a
  consultation for confirmation of pregnancy) as
  measured from the first day of the last normal
  menstrual period.
• The first antenatal visit is the first visit to a
  midwife or doctor arranged specifically for the
  purpose of providing maternity care. It excludes
  visits for confirmation of pregnancy and medical
  visits for incidental problems while pregnant.
• Record in completed weeks.

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Maternal medical conditions - precoded

• A new set of precoded conditions have been added
• O100 Pre-existing hypertension
• O2431 Pre-existing diabetes mellitus, non-insulin
  treated
• O2432 Pre-existing diabetes mellitus, insulin
  treated
• O2681 Renal disease specify
• O993 Psychosocial problems specify
• O994 Diseases of the circulatory system
  specify.
• Please provide more specificity where required.

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Obstetric complications - precoded

• A new set of precoded conditions have been added
• O149 Pre-eclampsia
• O2441 Diabetes mellitus arising at or after 24
  weeks gestation, diet controlled
• O2442 Diabetes mellitus arising at or after 24
  weeks gestation, insulin treated
• O365 Suspected fetal growth restriction
• O440 Placenta praevia without haemorrhage
• O441Placenta praevia with haemorrhage
• O459 Premature separation of placenta (abruptio
  placentae)
• O468 Other antepartum haemorrhage
• Z223 Carrier of streptococcus group B (GBS).

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Discipline of antenatal care provider

• The discipline of the clinician who provided most
  occasions of antenatal care.

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Number of ultrasounds

• Changes to gestation periods
• 10-14 Weeks
• 15-26 Weeks
• gt27 Weeks

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Procedure and operations - precoded

• A new set of precoded conditions have been added
• 1651100 Cervical suture for cervical shortening
• 9619703 Intramuscular administration of two doses
  of steroids antenatally.

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Artificial reproductive technology - indicator

• Whether artificial reproductive technology (ART)
  was used to assist this current pregnancy.
• If ART was used record the type of ART in
  Procedures and operations, for example IVF,
  Clomid, GIFT, ICSI.

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Date and time of onset of labour

• The date and time of onset of labour
• record a valid date and time
• fill with 8s if the mother has a planned or
  unplanned caesarean section with no labour
• 0000 and 2400 are invalid.

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Date and time of onset of second stage

• The date and time of the start of second stage of
  labour
• record a valid date and time
• fill with 8s if the mother has a planned or
  unplanned caesarean section and did not reach
  second stage
• 0000 and 2400 are invalid.

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Date and time of rupture of membranes

• The date on which the mothers membranes ruptured
  (spontaneously or artificially)
• record a valid date and time
• fill with 8s if the mother has a planned or
  unplanned caesarean section and membranes were
  ruptured at caesarean
• 0000 and 2400 are invalid.

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Time of birth

• The time of birth measured as hours and minutes
  using a 24-hour clock
• record a valid time
• 0000 and 2400 are invalid.

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Fetal monitoring in labour

• Methods used to monitor the well being of the
  fetus during labour
• 01 None
• 02 Intermittent auscultation
• 03 Admission cardiotocography
• 04 Intermittent cardiotocography
• 05 Continuous external cardiotocography
• 06 Internal cardiotocography (scalp electrode)
• 07 Fetal blood sampling
• 88 Other
• 99 Not stated / inadequately described.
• More than one method can be recorded.

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Birth presentation

• A new set of presentations have added
• 1 Vertex
• 2 Breech
• 3 Face
• 4 Brow
• 5 Compound
• 6 Cord
• 7 Shoulder
• 8 Other specify
• 9 Not stated / inadequately described.
• For a multiple pregnancy with differing
  presentations, record the presentation of the
  fetus for which the form is being completed.

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Events of labour and birth

• This has been split from the previous
  Complications of Labour, Birth or Postnatal
  item.
• Refers to medical and obstetric events arising
  after the onset of labour, during the labour and
  birth, including preparation for caesarean
  section.

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Discipline of intrapartum care provider

• The discipline of the clinician who is primarily
  responsible for making decisions regarding
  intrapartum care.

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Prophylactic oxytocic in third stage

• Whether an oxytocic was given prophylactically in
  the third stage of labour
• record yes when an oxytocic is used in order to
  prevent heavy blood loss, for example, with the
  birth of the anterior shoulder, or very soon
  after the birth.

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Manual removal of placenta

• Whether the placenta was manually removed
• this field should be left blank if method of
  delivery is via caesarean section.

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Perineal laceration degree/type

• The degree or type of laceration to the perineum
  following birth
• Now reported regardless whether the tear was
  sutured.
• For episiotomies extended by laceration or
  laceration extended by episiotomy record yes in
  the following fields
• Laceration
• Episiotomy
• Repaired
• Specify the degree of the tear in perineal
  laceration degree/ type.

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Perineal laceration repair

• Whether a repair to a laceration or incision to
  the perineum during birth was undertaken
• record the suturing of any injury to the
  perineum. Include repair to perineal, vaginal,
  clitoral or vulval lacerations and/or episiotomy
  (or other perineal incision).

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Estimated blood loss

• An estimate of the amount of blood lost at the
  time of birth and in the following 24 hours in
  millilitres (whether the loss is from the vagina,
  from an abdominal incision, or retained, for
  example, broad ligament haematoma)
• report the best estimate of the amount of blood
  lost in millilitres (mls). This is usually
  reported to the nearest 50 ml but may be more
  accurate than this if desired, for example, when
  there is very small amount of bleeding.
• Fill with 9s if unknown.

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Blood product transfusion - mother

• Whether the mother was given a transfusion of
  whole blood or any blood product (excluding
  anti-D) during her postpartum stay.

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Postpartum complications

• This has been split from the previous
  Complications of labour, birth or postnatal
  item.
• Refers to postpartum complications arising after
  delivery up to the time of separation from care.

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Baby UR number

• An identifier, unique to the baby, within the
  hospital or campus (patients record number/unit
  record number).
• This is an optional field, record if known.

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Condition (birth status)

• Condition of the baby at birth
• Now collecting the following
• 1 Liveborn
• 2 Stillborn (occurring before labour)
• 3 Stillborn (occurring during labour)

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Resuscitation method - mechanical

• A new set of methods have been added
• 01 None
• 02 Suction
• 03 Oxygen therapy
• 04 Intermittent Positive Pressure Respiration bag
  mask with air
• 14 Intermittent Positive Pressure Respiration bag
  mask with oxygen
• 05 Endotracheal intubation IPPR with air
• 15 Endotracheal intubation IPPR with oxygen
• 06 External cardiac massage ventilation
• 07 Continuous Positive Airway Pressure with air
• 17 Continuous Positive Airway Pressure with
  oxygen
• 88 Other
• 99 Not stated / inadequately described

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Resuscitation method - drugs

• Drugs administered immediately after birth to
  establish independent respiration and heartbeat,
  or to treat depressed respiratory effort and to
  correct metabolic disturbances
• 1 None (no drug therapy)
• 2 Narcotic antagonist
• 3 Sodium bicarbonate
• 4 Adrenalin
• 5 Volume expander
• 8 Other drugs
• 9 Not stated / inadequately described

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Hepatitis B vaccine received

• Whether the baby received an immunisation vaccine
  for hepatitis B during the birth admission,
  before or after seven days
• report the administration of a dose of paediatric
  hepatitis B vaccine. Do not report
  immunoglobulin.

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Breastfeeding initiation

• Whether the mother attempted to breastfeed the
  baby or express breastmilk at least once.

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Formula in hospital

• Whether any infant formula was given to this baby
  in hospital, whether by bottle, cup, gavage or
  other means.

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Last feed before discharge

• Whether the last feed prior to discharge was
  taken directly from the breast with no
  complementary feeding of any kind.

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Why are the VPDCU collecting the new data items?

• There is a demand from various sources including,
  DHS, researchers and health agencies, to have an
  understanding of the trends and outcomes in
  maternal and perinatal mortality and morbidity
  reporting.
• Previously the focus has been on mortality the
  current view is to concentrate more on morbidity.
• National and internationally perinatal collection
  units are now capturing and reporting on more
  morbidity items
• Some of the new items on the perinatal form
  include BMI, smoking and babys indigenous
  status.

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How will these new data items be used by the
VPDCU?

• To inform policy.
• To inform the recommendations that come from the
  Consultative Council in Obstetric and Paediatric
  Mortality and Morbidity (COPPM).
• To improve education, health resources, and
  assist in providing information for the planning
  of neonatal care units.
• The User Guide is a working draft, feedback on
  any area of reporting would be appreciated.
• The User Guide is available on the website for
  viewing and comment www.health.vic.gov.au/perinat
  al/pubs/guide.

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Revised perinatal data collection form
birth report
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User Guide Available on line at www.health.vic
.gov.au/perinatal/pubs/guide




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Support
Site visits liaison midwife visits Web site
online resource and support collaboration centre
- forum Newsletter Perinatal News, regular
updates Fact sheets resource for sites during
implementation 1300 number direct contact with
PDCU team Check your mouse-mat for further
details!





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