Welcome to the 2015 perinatal forum. It’s the 19th consecutive year and the ninth to
be titled the Annual Dr Brian Pridmore Perinatal Forum. So firstly, we’d like to acknowledge
this land that we meet on today as the traditional lands for the Kaurna people and that we respect
their spiritual relationship with their country. We also acknowledge the Kaurna people as the
custodians of the Adelaide region and that their cultural and heritage beliefs are still
as important to the living Kaurna people today. The edited version of this is placed on the
SA Health website. As you can see, it’s fairly easy to find and we certainly encourage
the use of this site and this function and it does depend on the number of hits that
are received. And so if you could please encourage people to have a look at the recording that’s
on the website and certainly people who aren’t able to attend, or haven’t been able to
attend tonight, we certainly encourage that to be viewed at some point.
So the Committee would also like to acknowledge the contribution that Ms Julia Ats, a midwife
from Burnside Hospital, has made to the sub-committee since 2004. Julia has now retired and decided
it’s time for another person to take on her role. So thank you Julia and best wishes
for your future.
We would also like to commend Robyn Kennare and Dr Wendy Scheil from the Pregnancy Outcome
Unit for all the hard work they do in helping to bring all the components of these events
together.
And a big thank-you to Dr Brian Wheatley who, as we know, has chaired this committee for
some time and has finally convinced Mojgan and myself to host this year, so thank you
Dr Wheatley.
So as a Sub-committee of the main Maternal and Perinatal Mortality Committee, we’re
also requested to each year bring to your attention the latest recommendations that
will appear in the most recent annual report. And so these were recommendations from 2013,
and we’ll just go through those briefly. The first of these recommendations, and these
are the provisional draft recommendations, talks about a root cause analysis, which is
recommended to be conducted in all cases of direct maternal death and potentially indirect
maternal death; that IV drug users, pregnant and non-pregnant, who have a febrile or inflammatory
condition should be investigated for endocarditis. That foetal growth restriction associated
with maternal hypertension should be recognised as pre-eclampsia and labour induced by 37
weeks gestation and, finally, to improve the rate of consent for autopsy. The first point
is that experienced or senior staff should seek parental permission, and families should
be informed of the value of a good quality autopsy in confirming antenatal diagnoses,
eliciting other findings which are significant in determining the cause of death, alleviating
parental guilt, helping with grieving process and parental counselling and understanding
patterns of disease.
So onto this year’s forum. We’ve changed the format a little in that, as we travel
the journey of the mock case scenario, our invited experts will give a short presentation
on their area of expertise. Following each presentation, there’ll be an opportunity
for you to ask questions of our experts, and we value as many as you like really. One of
the great strengths of these events over the years has been your participation and it’s
sometimes very lively, as we know. So the experts we’ve invited tonight are Professor
Kelton Tremellen, Ms Emma Angel, Dr Erin Clarke, Professor Robert Bryce, Dr Chris Munt and Ms
Elizabeth Kleinig. So we look forward to hearing their talks shortly.
Why have we chosen this as our topic this year? Well, I think you’d be living under
a rock if you haven’t noticed all of the headlines that have been coming out in the
last few years. Certainly, a lot of celebrities are in the media, particularly very recently,
with Michelle Bridges and her pregnancy and the controversy surrounding this. Looking
at the statistics obtained through the Pregnancy Outcomes Unit, we know that the proportion
of primiparous women with their first birth aged greater than 35 years throughout South
Australia has increased substantially, certainly over the last 25 years, or a bit over 25 years.
So if we look at the graph, in 1986, 2.7% of primiparous were between 35 and 39 years
and that’s compared now to 10.8%, which was at its highest in 2006. In 1986, 0.2%
were between 40 and 44 years of age compared to 2.4% in 2013. And interestingly enough,
in 1986 there were no primiparous women over 45 years of age and 0.2% in 2012. And so whilst
the numbers aren’t high, they’re certainly there.
And now I’ll hand over.
This is all the mock scenarios and cases and just a brief presentation. So Maria is a 45
year old woman. She’s a Professor of History working for the University of Adelaide. She’s
nulliparous. She’s married to Mark, 48 year old lawyer. He has two teenage children from
a previous relationship. Just some general information. Maria’s BMI is normal – 24.
Had an open appendicectomy at the age of 5 with a rupture of appendix. Otherwise, fit
and healthy. She takes Elevit, a pregnancy multi-vitamin. She has not had any known allergies,
drug allergies, non-smoker, doesn’t really drink any alcohol. The family history is there.
Both parents have essential hypertension onset in mid-50s. And her mother had pre-eclampsia
with her first pregnancy and required delivery at around 36 weeks. So they have been trying
for a pregnancy for the last six months. She has regular cycles every 28 days, lasting
for six days and she has really no real gynaecological history of note. So some limited investigations
have been done. Her GP has organised an Anti-Mullerian hormone level, which is undetectable, is very
low. All her other hormones like Luteinising Hormone, Follicle Stimulating Hormone, they
are normal. Thyroid function test and prolactin are normal range. She had a pelvic ultrasound
which basically was unremarkable. The Antral follicle count was 2, which is low and Mark
had a semen analysis which was entirely normal. So I now want to invite the first speaker,
Professor Kelton Tremellen. He’s a Fellow of the Royal Australian College of Obstetricians
and Gynaecologists and a sub-specialist in Clinical Reproductive, Endocrinology and Infertility.
He works as a clinician at Repromed and is a Professor of Reproductive Medicine at Flinders
University. He has a research interest in diminishing ovarian reserve and has been working
in that area for many years. And I’m delighted to invite him for a talk.