Obstetrics and Gynaecology



 

Services

​Obstetrics

All our obstetricians are specialists, and they are supported by experienced midwives. Specialist anaesthetists are available to help with pain relief, and neonatal paediatricians are available to attend to any newborns that require their skills. 


Sub-specialists in Obstetric and Gynaecological Ultrasound also practice within Epworth campuses. Services provided include Pre-Pregnancy education seminars, ante-natal classes, lactation consultants and access to the Park Hyatt. The ongoing post-natal care at the Hyatt provides a 5-star environment, privacy, and ongoing medical and midwifery support in close proximity to the Victoria Parade Medical Centre which houses many of the obstetricians, paediatricians and the Epworth Freemasons Maternity Department  

Gynaecology  

Epworth treats a wide spectrum of gynaecological conditions, with subspecialists in gynaecological cancer (CGO), subfertility (CREI) and urogynaecology (DU).


Conditions treated include: 

  • menstrual problems 
  • fibroids 
  • endometriosis
  • reproductive endocrinology, infertility 
  • prolapse, uro-gynaecology and urinary incontinence 
  • gynaecological oncology, pre-cancers and cancer


Activity


 

​      FY 2014

      FY ​2015

    FY 2016

Servi​ces

Admissions

Bed
days

Admissions

Bed
days

Admissions Bed
days​​

Gynaecology

12,824

17,848

14,169

19,558​

14,799​ 20,368​

Obstetrics

3,520

14,940

3,507

930

3,628​ 15,239​
         


 Highlights—Obstretrics

​​

  • Epworth is one of the largest obstetric services in the private sector. This gives us th scale required to deliver high quality care. In 2015, we delivered 3,020 babies.
  • The introduction of High Flow Oxygen into the Special Care Nursery to avoid unnecessary neonate transfers out.
​​

Highlights—Gynaecology​​


  • The majority of Victoria's IVF specialists consult in Epworth facilities. Many of these doctors are “sub-specialists” with the extra qualification of Certification in Reproductive Endocriniology and Infertility (CREI).
  • A significant proportion of IVF procedures in Victoria are performed at Epworth Hawthorn
  • Robotic gynaecological surgery is performed at Epworth Freemasons and  Epworth Eastern.
  • Gynaecological oncological surgery is performed at both Epworth Freemasons and Epworth Eastern.



Australian Council on ​Healthcare Standards – obstetrics 1H 2016


Ar​ea

Indi​cator

Epwor​th performance %

Benchmark or average national performance %

Performance comments

Ma​ternity

1.1 Selected primipara who have a spontaneous vaginal birth  

30.17

44.80

Performance below benchmark

Maternity

1.2 Selected primipara who undergo induction of labour  

45.37

38.10

Performance below benchmark​

Maternity

1.3 Selected primipara who undergo an instrumental vaginal birth

35.15

26.58

Performance below benchmark

Maternity

1.4 Selected primipara undergoing caesarean section  

34.68

28.99

Performance below benchmark

Maternity

2.1 Women delivering vaginally whose previous birth resulted in caesarean section

6.03

12.62

Perrformance below benchmark

Maternity

3.1 Selected primipara with an intact perineum or unsutured perineal tear

12.73

15.75

Performance matches benchmark​

Maternity

3.2 Selected primipara undergoing episiotomy AND no perineal tear while giving birth vaginally

53.45

33.74

Performance better than benchmark

Maternity

3.3 Selected primipara sustaining a perineal tear AND no episiotomy  

32.73

42.84

Performance better than benchmark

Maternity

3.4 Selected primipara undergoing episiotomy AND sustaining a perineal tear while giving birth vaginally

1.09

7.16

Performance better than benchmark

Maternity

3.5 Selected primipara requiring surgical repair of the perineum for third degree tear

0.73

5.04

Performance better than benchmark

Maternity

3.6 Selected primipara requiring surgical repair of the perineum for fourth degree tear

0.00

0.29

Performance better than benchmark

Maternity

5.1 Women who receive an appropriate prophylactic antibiotic at the time of caesarean section

100.00

94.09

Performance better than benchmark

Maternity

6.1 Women undergoing an emergency lower uterine segment caesarean section who receive appropriate pharmacological thromboprophylaxis.

100.00

79.40

Performance better than benchmark

Maternity

7.1 Women who give birth vaginally who require a blood transfusion during the same admission

1.12

1.28

Performance better than benchmark

Maternity

7.2 Women who undergo caesarean section who require a blood transfusion during the same admission

0.73

1.31

Performance better than benchmark

Maternity

8.1 Deliveries with birth weight less than 2750g at 40 weeks gestation or beyond

1.15

1.35

Performance better than benchmark

Maternity

9.1 Term babies born with an Apgar score of less than 7 at five minutes post delivery

0.74

1.32

Performance better than benchmark

Maternity

10.1 Inborn term babies transferred / admitted to a neonatal intensive care nursery or special care nursery for reasons other than congenital abnormality

6.56

10.59

Performance better than benchmark​

 

Our number one aim is to deliver mother and baby in the best possible condition. 

There are three obstetric indicators that are outliers when compared with the other submitting hospitals in the General Comparison set. We have higher operative delivery rates and higher induction rates. The patients treated at Epworth Freemasons are not the same population as the “average” patient. When compared with the Peer (Private hospitals; n=5), Epworth Freemason remains within the targets. 


One of the key reasons we are outliers in the three areas is the data submitted to the Indicator Program is not filtered for age and our patient population is older than the average. The national figures include many young women with uncomplicated pregnancies. Patients booked for sophisticated private hospital care, such as Epworth Freemansons, are generally higher risk with more complications than the average profile of patients nationally.


On all the parameters related to preserving the perineum, Epworth Freemason’s percentages are better than the benchmark. Undertaking an appropriate episiotomy prevents vaginal tears, as shown by the above figures.


Episiotomy benefits


  1. The higher episiotomy rate in primipara and no vaginal tear can be attributed to the use of episiotomy to reduce the risk of anal sphincter injuries which have many long term and serious consequences for a woman’s physical and mental health.
  2. An episiotomy is far more preferential than a 3rd of 4th degree tear. 
  3. Other reason for use: Required at times to “facilitate instrumental assisted deliveries”.


Epworth Freemasons achieves better results than other hospitals in addressing VTE and antibiotic prophylaxis. As well, our blood transfusions rates for both vaginal deliveries and Caesarean sections are lower than other hospitals. This is a good result because it indicates the expertise and experience of our obstetricians. 


Our performance—gynaecology​​​


Audit for improved outcomes for women: Australian Council on Healthcare Standards – Gynaecology 1H 20016.

Area​​

Indicator​

Epworth performance %

Benchmark or average national performance %

Performance comments

Gynaecology

1.1 Gynaecological surgery for benign disease - unplanned intraoperative or postoperative blood transfusion

0.29

0.72

Performance above benchmark 

Gynaecology

1.2 Gynaecological surgery for malignant disease - unplanned intraoperative or postoperative blood transfusion

9.57

7.40

Performance below benchmark 

Gynaecology

2.1 Patients suffering injury to a major viscus with repair, during a gynaecological operative procedure or subsequently up to 2 weeks post-operatively

0.72

0.67

Performance below benchmark 

 

The graph below shows our performance on the above indicators over time.

Image: Graph depicting gynaecology performance on the above indicators over time

Since 2H 2012 – 1H2015, Freemasons has not triggered as an outlier in the above indicator sets when compared with General or Peer Comparisons Sets.


Our above average intraoperative and postoperative transfusion rates reflect our surgeons desire to accelerate patient recovery, It is well recognised that anaemia delays recovery and we have a desire to make the patient’s post-operative recovery as speedy and uncomplicated as possible.

Risk of viscous injury is extremely low in both groups. 


Queries

If you have any queries regarding the data on this page, please email ClinicalProfile@epworth.org.au



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