||Prof Elizabeth Sullivan
University of Technology Sydney
Professor Sullivan is Assistant Deputy Vice Chancellor Research University Technology Sydney (UTS) and an internationally renown public health physician with over 25 years' experience as a medical epidemiologist, specialising in the fields of perinatal, maternal, sexual and reproductive health.
Professor Sullivan is a member of the NHMRC for the triennium 2015-2018 and member of the Obstetrics Clinical Committee of the Medicare Benefits Schedule (MBS) Review Taskforce. Professor Sullivan is Chair of the inaugural UTS SAT for the Science in Australia Gender Equity (SAGE) National Pilot of Athena SWAN
and is committed to the advancement of gender equity in academia. Professor Sullivan has a nationally successful track record of research development and management, with more than $20 million in research funding as a chief investigator, longstanding national and international collaborations, and over 170 peer review publications and AIHW and WHO reports.
Professor Sullivan established and is chief investigator of AMOSS that researches severe maternal morbidity and mortality. She is internationally recognised for her innovative program of population health and health services research that focuses on vulnerable reproductive populations.
Title: Rheumatic heart disease in pregnancy in Australia, an AMOSS population study: maternal and infant outcomes
Background: Although rheumatic heart disease (RHD) in Australia is a rare condition, it is disproportionately prevalent among Indigenous peoples in the top end of Australia. RHD in pregnancy is associated with inferior maternal and perinatal outcomes. This is the first national study of RHD in pregnancy conducted worldwide.
Method: A population-based, prospective, observational study of pregnant women with RHD who gave birth in Australia in 2013-2014, utilising the Australasian Maternity Outcomes Surveillance System (AMOSS). The study was conducted in Australia and New Zealand with Australian results presented.
Results: Of the 188 women with RHD who gave birth, 79% (n=149) were Indigenous, with the prevalence ranging from 3.2/10,000 (all) women giving birth to 211/10,000 Indigenous women giving birth in the Northern Territory. Of the 188 women: 64% lived in remote Australia, 11% were newly diagnosed with RHD during pregnancy or postpartum, 14% had a history of cardiac interventions or surgery; 7% had no echocardiogram and 21% no cardiac assessment during pregnancy. 10% were admitted to hospital antenatally for a cardiac indication. 55% had a transfer of care antepartum, 5% intrapartum and 45% postpartum. There was one maternal death, and 16% of mothers were admitted to an intensive care unit (ICU), coronary care unit (CCU) or high dependency unit (HDU) for >2 days.The stillbirth rate was 26.5/1000 births, 23% were preterm and neonatal mortality rate was 6.5/1000 births.
Conclusions: RHD in Australia remains a disease of disadvantage and is found predominantly among Indigenous women. It is characterised by low rates of health literacy, fragmented care and inferior perinatal outcomes consistent with other severe chronic conditions in pregnancy. Better access to preconception counseling and pregnancy planning; early diagnosis of new cases in pregnancy, collaborative models of cardiac and maternity care and careful monitoring of women throughout pregnancy, birth and the puerperium is warranted.
Acknowledgement of funding from the National Health and Medical Research Council APP1024206
Title: Australasian Maternity Outcomes Surveillance System (AMOSS) and Maternal Mortality
Background: Maternal mortality remains rare in Australia with the most recent Maternal deaths in Australia 2008–2012 reporting 105 maternal deaths in Australia or a maternal mortality ratio of 7.1 deaths per 100,000 women who gave birth in Australia. The Australasian Maternity Outcomes Surveillance System (AMOSS) was established in 2009 as a national surveillance and research system of severe and rare conditions in pregnancy, many of which remain the leading causes of maternal mortality in Australia. The aim of this presentation is to describe the maternal deaths from these conditions and the utility of maternal mortality as an indicator of maternity care in Australia.
Method: Population-based, surveillance of women giving birth with AMOSS conditions between 2009 and 2015 in Australia. Conditions included: 2009 aH1N1 influenza with intensive care unit admission, amniotic fluid embolism (AFE), antenatal pulmonary embolism, placenta accrete, eclampsia, super obesity, massive obstetric haemorrhage requiring rapid blood transfusion, gestational breast cancer and rheumatic heart disease; and one intervention peripartum hysterectomy.
Results: Of the 1414 women with rare conditions who gave birth and were included in the study, there were 15 maternal and 1 late maternal death reported. The overall case fatality rate for the eight conditions was 1.1%, ranging from no deaths in eclampsia, massive obstetric haemorrhage and super obesity to 29.3% in women with an AFE. The case fatality for women having a peripartum hysterectomy was 0.6% with the underlying conditions being placenta accrete and uterine atony.
Conclusions: Surveillance of maternal mortality and severe maternal morbidity is an essential component of maternal health programs. Rare and severe conditions in pregnancy are under-researched with limited information on maternal outcomes. Maternal mortality is an essential outcome but limited in a context where death is uncommon even in severe conditions. Agreement on a national set of essential maternal morbidity outcomes is needed to better inform maternity policy and practice.