This research is a preplanned sub-study of the retrospective cross-sectional observational audit that evaluated adherence to clinical practice guidelines for South Australian pregnant women with cardiac conditions between 2003 and 2013. Details of the study design, data abstraction tool, settings, selection criteria and the evaluation of adherence to clinical practice guidelines across three hospital sites were published previously. In summary, we showed that variance in adherence correlated with the exposure to the higher acuity cases and appropriate up-referral to the only high risk referral centre for the state, the quartenary hospital two, which provided (level six) care, i.e. maternal cardiac and neonatal intensive care services. Likewise, hospital one offered intermediate care (level five) inclusive of tertiary maternal services, intensive care and specialised neonatal care services but excluded babies less than 32 weeks. Also, hospital three was a stand-alone maternity unit attached to a large neonatal intensive care, yet without a maternity intensive care service onsite [20].

The previous study evaluated the adherence to recommendations within the guidelines. The predictors for adherence were examined, such as the hospital sites, the two broad cardiac groups, underlying cardiac causes, risk level of pregnancy, multidisciplinary team collaboration, maternal and baby demographic factors. The participants included only women with ‘preexistent’ and ‘newly acquired’ heart disease during pregnancy, with a more comprehensive discussion on the selection criteria presented in Millington (2020) et al. [20].

The cohort’s broad spectrum of maternal cardiac diagnosis and neonatal diagnosis which includes rare syndromes namely Scimitar, Goldenhar and Noonan are available in S1 and S2 Tables [2426].

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