Australasian Maternity Outcomes Surveillance Study (AMOSS)Data are collected from maternity units that have greater than 50 births per year across Australia and New Zealand. The project is based at the Faculty of Health, University of Technology Sydney. AMOSS is the umbrella term for an ongoing series of studies of population based, collaborative research studies that combines a clinical and population health approach to describe the burden of rare and severe events in pregnancy, childbirth and the postnatal phase. The success of AMOSS in carrying out its objectives is dependent on close working relationships with its partners across public and private health care systems throughout Australasia. Substantive funding for AMOSS has been provided through a five-year NHMRC grant and subsequent four year NHMRC grant as well as funding from the National Breast Cancer Foundation, International Vasa Praevia Foundation, Royal Hospital for Women Foundation and collaborative funding from the Australian Red Cross Blood Services. AMOSS stakeholders and partners include study chief and associate investigators; state/territory representatives in all Australian states and territories and New Zealand; Professional Colleges: RANZCOG, ACM, NZCM, ANZCA, SOMANZ, RACP, PSANZ, ANZICS; obstetric health information expert; DoHA representative; statistics and epidemiology experts; Aboriginal and Torres Strait Islander community representatives; consumers. Case identification is prospective. Non-identifiable data are collected on selected AMOSS conditions (known as the AMOSS data collection) from maternity units that have greater than 50 births per year across Australia and New Zealand. A data coordinator is nominated within each maternity unit to respond to the AMOSS surveys/questionnaires. Electronic monthly reporting on rare conditions is used with a negative reporting system in place. Incidence and case-control studies are conducted. Only population-level data are published and findings are disseminated through peer-reviewed journals, presentations, reports and newsletters. The AMOSS system is designed to study conditions or interventions based on clinical need or health priorities and meet the needs of end users. Each condition is under surveillance for one year, unless specified. Conditions have an estimated incidence of less than 1 in 1,000 births per year. Conditions that have been or are currently being studied are:
Completed studies:
• Antenatal pulmonary embolism
• Eclampsia
• Morbid obesity (BMI >50)
• Placenta accreta
• Peripartum hysterectomy
• Influenza in pregnancy (ICU admission)
Current studies:
• Amniotic fluid embolism
• Gestational breast cancer
• Rheumatic heart disease
• Vasa praevia
• Massive obstetric haemorrhage. Research data are published and findings are disseminated through peer-reviewed journals, presentations, the AMOSS annual report and newsletters. One of the strengths of the system is its ability to respond to events and clinical needs, as evident in the collaborative study with the Australian and New Zealand Intensive Care Society of Intensive Care Admission during the 2009 H1N1 pandemic. 1) The surveillance system has employed negative reporting—the AMOSS data coordinator is required to submit nil case responses to minimise missing data.
2) The web-base reporting system confirms which hospitals have reported each month. Non-responding sites are then followed up with a (semi-automatic) reminder email and, if required, further manual queries by email and phone.
3) The AMOSS study on extreme morbid obesity in pregnancy has been validated against perinatal data collections in NSW, Qld and WA. AMOSS has been developed to conduct accessible, high quality national research on rare and severe conditions of pregnancy and/or interventions during pregnancy and the puerperium, with the aim of improving the safety and quality of maternity care. AMOSS seeks to make data publicly accessible, with contemporaneous reports obtainable via the AMOSS website.Data sharing requests will be considered by the AMOSS co-investigator group.
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