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Table 1 Planned evaluation measures relating to the five elements of the Safer Baby Bundle

From: Implementation and evaluation of a quality improvement initiative to reduce late gestation stillbirths in Australia: Safer Baby Bundle study protocol

Element Level of evaluation Measure
Element 1: supporting women to stop smoking in pregnancy Process Proportion of women who are asked about their smoking status at first antenatal care visit and at 28 weeks antenatal appointment.
Proportion of women who undertake exhaled breath carbon monoxide analysis at first antenatal care visit and at 28 weeks antenatal appointment.
Proportion of women, identified as smoking or recent quitters at first antenatal care visit, who are provided with advice on the benefits of quitting.
Proportion of women, identified as smoking, with documented referral to smoking cessation service (e.g. Quitline).
Impact Proportion of women, identified as smoking, with documented referral to smoking service who engaged with a smoking cessation service.
Percentage of women who cease smoking between first antenatal care visit and birth
Element 2: improving detection and management of FGR Process Proportion of women with documented risk assessment for FGR at first antenatal care visit.
Proportion of women (at any gestation) identified as at risk of FGR whose care was escalated as per the FGR care pathwaya.
Proportion of women with SFH measurement taken and plotted on growth chart at each antenatal visit from 24 weeks’ gestation.
Proportion of stillbirths from 28 weeks’ gestation where substandard care for FGR detection or management are identified
Maternity services impact Proportion of term births with undetected FGR defined as severely growth restricted singletons (less than 3rd centile) undelivered at 40 weeks’ gestation (missed FGR)
Outcome Proportion of singleton babies delivered for suspected FGR at 37 weeks’ gestation or more who have a birthweight >25th centile.
Element 3: raising awareness and improving care for women with DFM Process Proportion of women provided with DFM information by 28 weeks’ gestation.
Maternity services impact Proportion of women with singleton pregnancies who have a CTG commenced within 2 hours of presenting (in person) at the maternity service with DFM, from 28 weeks’ gestation.
Proportion of stillbirths from 28 weeks’ gestation where substandard care for DFM reporting or management are identified
Percentage of women at 28 weeks’ gestation or more who attend a maternity service within 12hrs of DFM concern.
Proportion of women with singleton pregnancies who present with DFM who undergo induction of labour or elective caesarean section before 39 weeks’ gestation for DFM as the only indication.
Element 4: improving awareness of maternal safe going-to-sleep position in late pregnancy Process Proportion of women who, by 28 weeks’ gestation, were given the information brochure on safe going-to-sleep position in late pregnancy.
Impact Proportion of women who report safe sleep practices after 28 weeks’ gestation.
Proportion of women after 28 weeks’ gestation who can describe safe sleep practices (going to sleep on their side).
Element 5: improving decision making about the timing of birth for women with risk factors for stillbirth Process Proportion of women assessed for stillbirth risk factors at first antenatal care visit
Proportion of women reassessed for stillbirth risk factors at 34-36+6 weeks’ gestation
Impact Proportion of women who report being involved as much as they wanted in decision-making about timing of birth
Outcome Proportion of women with singleton pregnancies who undergo induction of labour or elective caesarean section before 39 weeks’ gestation.
  1. Abbreviations: FGR Fetal growth restriction, SFH Symphyseal-fundal height, DFM Decreased fetal movements, CTG Cardiotocography
  2. aPSANZ/Stillbirth CRE FGR care pathway for singleton pregnancies [21]