Improving perinatal care

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Improving the evidence base of perinatal clinical care

Assoc Prof James King

As a member of the Cochrane Collaboration's Pregnancy and Childbirth Collaborative Review Group and its Neonatal Collaborative Review Group, Assoc Prof King undertakes systematic reviews of the available research evidence to help define best clinical practice management strategies in perinatal medicine. Examples of recently completed reviews include the place of antibiotics in the management of preterm labour, the use of anti-platelet agents for preventing and treating pre-eclampsia, and the role of calcium channel blockers for inhibiting preterm labour.

Improving clinical management of pregnancy complications

Assoc Prof Louise Kornman, Clin Assoc Prof Mark Umstad, Clin Assoc Prof Ricardo Palma Dias, Clin Assoc Prof Fabricio da Silva Costa, Dr Penny Sheehan, Assoc Prof Joanne Said, Dr Andrea Khaw, Prof Shaun Brennecke

The contemporary emphasis on the efficient use of increasingly limited health sector resources makes it imperative that cost-effective, evidence-based clinical managements with high customer satisfaction ratings are identified and utilised.

Thus, clinical staff at the Department are investigating the cost-effectiveness of different approaches to labour induction in cases of prolonged pregnancy; the safety, cost and patient satisfaction associated with Pregnancy Day Care Centre management of disorders such as pre-eclampsia or fetal growth restriction; antenatal factors which predict the perinatal outcome in various fetal congenital malformations; tests to predict miscarrage and preterm birth, and new techniques for maternal-fetal welfare assessment during pregnancy, such as ambulatory blood pressure monitors and computerised fetal heart rate recording systems.

Inherited thrombophilia and pregnancy outcome

Prof Shaun Brennecke, Assoc Prof Joanne Said, Dr Amy Chui, Prof John Higgins, Assoc Prof Vera Ignjatovic, Prof Paul Monagle

Several disorders of the clotting system have been identified which predispose people to blood clots in their leg veins and other parts of the body. Collectively these disorders have been called thrombophilias. A relationship between thrombophilia and pregnancy complications such as preeclampsia (toxaemia of pregnancy), intrauterine growth restriction (baby growing less than expected during pregnancy), stillbirth (unexpected death of the baby in the womb) and placental abruption (bleeding from behind the placenta) has been suggested recently in a number of studies. The placentas of patients with pregnancy complications often contain blood clots so it is possible that patients who have a condition that predisposes them to blood clots may be more likely to get blood clots in the placenta and hence develop pregnancy complications. These pregnancy complications are major contributions to perinatal and maternal morbidity and mortality.

Early diagnosis of common pregnancy disorders

Clin Assoc Prof Fabricio da Silva Costa, Dr Bill Kalionis, Prof Shaun Brennecke

There is an important need in modern obstetric care for non-invasive blood-based tests for the accurate assessment of the risks early in pregnancy that patients will develop common pregnancy disorders. The aim of this project is to develop these types of tests for the pregnancy disorders pre-term labour, pregnancy-induced hypertension/pre-eclampsia, fetal growth restriction and gestational diabetes. Although these diseases affect between 15 and 25% of deliveries in Australia and have a significant impact on the health and wellbeing of mothers and their babies, diagnosis is made in the clinic only after they are well established. Available predictive tests provide relatively poor estimations of risks. The placenta plays a critical pathogenic role in the pregnancy disorders and altered placental protein expression and release into maternal blood are important features of the disease process in each case.

This project uses a proteomics approach to identify candidate placental proteins that may be suitable for development as predictive tests. Evaluation of the predictive/early diagnostic capacity of the protein biomarkers is made by measuring their concentrations in maternal blood prior to clinical manifestation of disease.

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