Towards improving maternity care for women with vasa praevia : a mixed methods study

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𝐈𝐧𝐭𝐫𝐨𝐝𝐮𝐜𝐭𝐢𝐨𝐧 Vasa praevia is one of the causes of perinatal mortality and morbidity. In 2012, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists issued the first national guidance on vasa praevia. This statement recommended screening women who have risk factors for vasa praevia, and early caesarean section for women with an antenatal diagnosis of vasa praevia. These interventions are to improve perinatal outcomes. The rarity of this condition has been a significant obstacle for health researchers to conduct high-impact quality studies to enable the development of a national clinical guideline. Hence, women with this condition often seem to receive different approaches from care providers, which has been shown to cause stress and worry in some women. 𝐌𝐞𝐭𝐡𝐨𝐝𝐬 Utilising a mixed methods design, this thesis aimed to investigate the views of midwives and obstetricians regarding antenatal diagnosis of vasa praevia, describe the impact of perinatal deaths due to vasa praevia on these clinicians, and identify the actions required to improve the capabilities of these professional groups to care for the affected women. Phase one investigated the views and current practice of 453 obstetricians in Australia and New Zealand through a bi-national survey. In Phase two, a descriptive qualitative research, 22 obstetricians and 20 midwives practising across Australia were interviewed to explore the experience of caring for women with vasa praevia. 𝐑𝐞𝐬𝐮𝐥𝐭𝐬 There was a lack of consensus from obstetricians on the definition of vasa praevia. Despite high acceptability of screening women with risk factors for vasa praevia (70%), there was a low awareness (17%) about the risk factors. The qualitative study identified the devastating impact of adverse perinatal outcomes due to undiagnosed vasa praevia on the midwives and obstetricians. This was a driving force for antenatal screening and diagnosis. However, lack of knowledge at the clinician level and lack of local policy, information for women and research about vasa praevia at the health system level were the reported barriers to the provision of safe, high-quality care. 𝐂𝐨𝐧𝐜𝐥𝐮𝐬𝐢𝐨𝐧 The findings establish the need for standardising the process of screening, diagnosis and care of women with vasa praevia. This can be achieved by developing local policies at each ultrasound facility and maternity hospital, educating clinicians, and developing lay information for women affected by this condition. Furthermore, clinicians should be prepared and supported to deal with adverse patient outcomes, and work with families to improve experiences and outcomes.
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