Delivery in the 'grey zone': collaborative approach to extremely preterm birth.

During the recent New South Wales and Australian Capital Territory consensus workshop on Perinatal Care at the limits of viability, recommendations were made in the areas of education, counselling and management. Critically, there was a consensus that between 23 weeks and zero days and 25 weeks and six days of gestation, it was reasonable to offer the option of non-initiation of resuscitation and intensive care. Within this, obligation to treat increases as the gestation advances.

Getting an evidence-based post-partum haemorrhage policy into practice.

Background: Post-partum haemorrhage (PPH) is a potentially life-threatening complication of childbirth occurring in up to 10% of births. The NSW Department of Health (DoH) issued a new evidence-based policy (Framework for Prevention, Early Recognition and Management of Post-partum Haemorrhage) in November 2002. Feedback from maternity units indicated that there were deficiencies in the skills and experience is needed to develop the written protocols and local plans of action required by the Framework.

Perinatal care at the borderlines of viability: a consensus statement based on a NSW and ACT consensus workshop.

Perinatal care at the borderlines of viability demands a delicate balance between parents' wishes and autonomy, biological feasibility, clinicians' responsibilities and expectations, and the prospects of an acceptable long-term outcome - coupled with a tolerable margin of uncertainty. A multi-professional workshop with consumer involvement was held in February 2005 to agree on management of this issue in New South Wales and the Australian Capital Territory. Participants discussed and formulated consensus statements after an extensive consultation process.

Trends in postpartum haemorrhage.

Objective: To assess trends and outcomes of postpartum haemorrhage (PPH) in New South Wales (NSW).

Methods: A population-based descriptive study of all 52,151 women who had a PPH either during the hospital stay for the birth of their baby or requiring a re-admission to hospital between 1994 and 2002. Data were obtained from the de-identified computerised census of NSW hospital in-patients and analysed to examine trends over time.