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Background: Queensland introduced a colour‐coded cardiotocograph (CTG) classification system (green, blue, yellow and red) to complement the Royal Australian and New Zealand College of Obstetricians and Gynaecologists prose‐based classification system of 'low, unlikely, maybe or likely' fetal compromise. Aims: The aim of the study was to determine the clinical impact of the introduction of the colour‐coded CTG classification system compared to the prose‐based system. We hypothesised there would be no change in the rate of operative delivery for intrapartum fetal compromise (OD‐IFC). Materials and methods: This retrospective non‐inferiority study from November 2014 to May 2018 used routinely collected data from the Mater Mother's Hospital. Non‐insured women with a singleton, non‐anomalous, cephalic fetus at term, attempting a vaginal birth with continuous intrapartum CTG were included. The primary outcome was OD‐IFC. Secondary outcomes included various obstetric and perinatal outcomes. Non‐inferiority analysis was performed with a pre‐specified non‐inferiority margin of 2% risk difference. Results: Eleven thousand seven hundred and twenty‐seven participants were included. The OD‐IFC rate was similar across the study groups (prose‐based 15.1% vs colour‐coded 15.3%, adjusted odds ratio (aOR) 1.02, 95% CI 0.93–1.13) with the adjusted risk difference of 0.29% (95% CI −0.98 to 1.56), which did not exceed the inferiority margin. There were more spontaneous (aOR 1.11, 95% CI 1.04–1.19) and fewer instrumental (aOR 0.87, 95% CI 0.80–0.95) vaginal births in the colour‐coded cohort. There were no differences in neonatal outcomes. Conclusions: Reassuringly, the colour‐coded CTG classification system was non‐inferior to the prose‐based system, did not influence OD‐IFC but was associated with more spontaneous vaginal deliveries. [ABSTRACT FROM AUTHOR]

Background: Placenta praevia (PP) is a rare obstetric condition associated with significant maternal and perinatal morbidity. Traditionally, the degree of PP has been classified into minor and major; however, there are very few robust studies that compare the maternal outcomes of these types of PP. Aims: To identify any significant differences in obstetric outcomes between major and minor PP, including antepartum, intraoperative and postpartum complications. Materials and Methods: A retrospective cohort study was conducted at the Royal Brisbane & Women's Hospital between 2009 and 2018; all women were diagnosed with PP. Results: Of the total of 368 women recruited, over half of the participants were diagnosed with major PP (57%), while the remaining had minor PP. Women with major PP, compared to women with minor PP, had an increased risk of antepartum haemorrhage (odds ratio (OR) 2.77, P < 0.001), delivery at an earlier gestational age (36.1 vs 37.4 weeks), general anaesthesia (OR 3.25, P < 0.001), greater proportion of emergency lower segment (51% vs 40%) and classical caesarean (7.7% vs 3.8%), increased number of uterotonics (incidence rate ratio (IRR) 1.17, P < 0.031), greater blood loss (IRR 1.32, P < 0.001) and higher frequency of blood transfusion (IRR 2.00, P < 0.027), and longer postpartum hospital stay (IRR 1.26, P < 0.001). Hysterectomy was performed for three women with major PP, compared to one with minor PP. Conclusions: The degree of PP significantly impacts obstetric outcomes, with major PP associated with worse maternal morbidity antenatally, intraoperatively and postpartum. Therefore, to optimise patient care, this study emphasises the importance of identifying and distinguishing between different types of PP. [ABSTRACT FROM AUTHOR]

Background: Preterm birth is associated with significant perinatal morbidity and mortality. The fetal fibronectin test (fFN) is used to manage women presenting with threatened preterm labour (TPTL). Aim: To evaluate the use of fFN in women presenting with TPTL with regard to hospital admission, tertiary hospital transfer and use of tocolytics and steroids in our hospital, against recommended guidelines. The ability of fFN <10 ng/mL, 10–49 ng/mL, 50–199 ng/mL and >200 ng/mL to predict outcome was also examined. Material and Methods: This was a single‐centre retrospective study from January 2015 to June 2017. All women who presented to Ipswich hospital, a level two facility for births at >32 weeks of gestation, between 23 and 346 weeks of gestation with TPTL and who had fFN tests were included in the study. Results: Fetal fibronectin <50 ng/mL had a negative predictive value of 93.5% (95% CI 86.5–97.1). Despite this assurance, one in four presentations resulted in hospital admission and nearly one in ten in steroids and tocolysis administration. Birth <34 weeks was 0% for fFN <10 and 2% for women with fFN levels <200 ng/mL compared to nearly 30% for levels >200 ng/mL. Conclusion: There is noncompliance with use of fFN to its full potential. This small study also provides support for the use of a 200 ng/mL cut‐off fFN level for birth <34 weeks. This would avoid the need to transfer to a tertiary facility many women who present with TPTL. [ABSTRACT FROM AUTHOR]