Shared antenatal care between family health services and hospital (consultant) services for low risk women

Obstetric profiles and perinatal mortality among Pacific Island immigrants in New South Wales, 1990-93

OBJECTIVES

To describe the obstetric profile and perinatal mortality of Pacific Island-born women giving birth in New South Wales (NSW) and assess risk factors associated with the high perinatal death rate previously noted in this immigrant group.

METHOD

Retrospective cohort study based on the Midwives Data Collection in NSW from 1990 to 1993. Births to 5,034 Pacific Island-born women were compared with births to 256,843 Australian-born women.

RESULTS

Pacific Island-born women had fewer teenage pregnancies and were of an older age and higher parity. They were more likely to be married or in a de facto relationship and to present for antenatal care later in the pregnancy. The proportion of low birthweight and preterm birth was similar in the two groups but Pacific Islanders had a higher perinatal mortality rate (14.6/1,000 vs. 10.3/1,000, RR = 1.42, 95% CI = 1.13-1.54). Even at normal and high birthweights, infants of Pacific Island-born women were at greater risk of perinatal death. After adjusting for maternal factors (marital status, insurance status, parity and maternal age) Pacific Islanders were 30% more likely to have a perinatal death (OR = 1.30, 95% CI 1.07-1.54).

CONCLUSIONS

Further analyses of the causes of perinatal death in Pacific Island-born women are needed so appropriate interventions can be implemented.

IMPLICATIONS

The need for the design and evaluation of culturally specific services aimed at improving antenatal care attendance in Pacific Islanders is emphasised. Conventional risk assessment may not adequately predict adverse perinatal outcomes in all populations.