Pregnancy Assessment and Treatment for Health (PATH) Project

At Maitland Antenatal Clinic, we're improving obstetric outcomes by implementing preventative healthcare to reduce the number of women who develop pre-eclampsia.

Across NSW, rates of stillbirth, preterm birth and pre-eclampsia have stagnated, particularly in regional and rural areas. A major issue is the delay in pregnant individuals accessing specialist care, with the average gestational age for a first visit to our unit, the Maitland Antenatal Clinic, being consistently around 18-20 weeks. This is significantly later than the optimal window for preventative measures.

This delay is particularly concerning as studies show that early intervention, ideally before 16 weeks, significantly improves outcomes, including preventing pre-eclampsia and fetal growth restriction. While metropolitan health centres have made positive strides by redesigning early antenatal services, regional areas such as Maitland have struggled to provide consistent access to timely, evidence-based screening and specialist care.

Improving outcomes with preventative healthcare

The Pregnancy Assessment Towards Health (PATH) Project aims to improve obstetric outcomes in the Maitland Antenatal Clinic by implementing preventative healthcare measures that reduce the likelihood that pregnant women will develop pre-eclampsia. We developed a plan to:

• offer earlier antenatal visits
• ensure that pre-eclampsia screening occurred against a recognised standard
• ensure that time-critical and evidence-based interventions with low-dose aspirin is provided to women identified as high-risk.

By doing this, we seek to offer equitable, evidence-based care to pregnant women, leading to healthier pregnancies and better outcomes for families in regional areas.

Whole of service implementation

In consultation with our project sponsor, we developed a two-stage implementation plan, recognising that incorporating more accurate first-trimester screening methodologies would require additional resourcing. With this in mind, we decided to implement history-based screening and evaluate test results based on this approach to justify moving to the implementation’s second stage.

To help us see pregnant women earlier, we created a detailed map of the current process, from the time of referral to booking visit. We undertook a benchmarking exercise with our local tertiary hospital, John Hunter Hospital. They have implemented an Initial Maternity Assessment and Planning Program to address the problems we also want to solve.

We consulted our steering committee  to decide if we should run a pilot program, phase implementation or launch a whole of service implementation. We decided to implement the project across the whole service to reduce staff reverting to previous practices. This occurred in March 2025 by implementing a two-step first booking visit with pregnant women, which includes a phone and face-to-face appointment. A collaborative approach incorporating an obstetrician and midwife consultation is offered to all women as part of the face-to-face appointment.

Average gestational age of first visit closer to 18 weeks

We analysed the results from the first four weeks of implementation and compared them with available baseline data. Results showed that all but one patient (103/104) received history-based screening. Of those identified as high-risk, 66% (10/15) received preventative treatment with low-dose aspirin. Of the five women who did not receive preventative treatment, four women were seen too late into their pregnancies and one was missed.

These results were a significant improvement on the baseline data, where only 17% of high-risk pregnancies received preventative treatment. The average gestational age during a first visit is now nearly 18 weeks, moving closer to our 16 weeks goal. Although it is early days for the project, these results are encouraging.

While this transition phase was anticipated, it was difficult to assess the demand prospectively, due to fluctuating levels of GP referrals and the ‘hold over’ of referrals from the old to the new system. Ongoing monitoring will be required to determine whether the new system holds adequate capacity for the demand once the transition phase has settled.

View this project's poster from the Centre for Healthcare Redesign graduation May 2025.

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