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Goldenberg RL, Griffin JB, Kamath-Rayne BD, Harrison M, Rouse DJ, Moran K, Hepler B, Jobe AH, McClure EM. Clinical interventions to reduce stillbirths in sub-Saharan Africa: a mathematical model to estimate the potential reduction of stillbirths associated with specific obstetric conditions. BJOG 2018; 125:119-129. [PMID: 27704677 DOI: 10.1111/1471-0528.14304] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2016] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Stillbirths are among the most common adverse pregnancy outcomes, with 98% occurring in low-income countries. More than one-third occur in sub-Saharan Africa (SSA). However, the medical conditions causing stillbirths and interventions to reduce stillbirths from these conditions are not well documented. We estimated the reductions in stillbirths possible with combinations of interventions. DESIGN We developed a computerised model to estimate the impact of various interventions on stillbirths caused by the most common conditions. The model considered the location of obstetric care (home, clinic or hospital) and each intervention's efficacy, penetration and utilisation. Maternal transfers were also considered. SETTING AND POPULATION Pregnancies in SSA in 2012. METHODS For each condition, we created a series of scenarios involving different combinations of interventions and modelled their impact on stillbirth rates. MAIN OUTCOME MEASURES Stillbirths associated with various maternal and fetal conditions and the percentage reduction with various interventions. RESULTS Eight to ten maternal and fetal conditions were responsible for most stillbirths, but none for more than 15%. The most common conditions causing stillbirths in SSA include obstructed labour and uterine rupture, fetal distress and umbilical cord complications, fetal growth restriction, pre-eclampsia/eclampsia, and placental abruption/placenta praevia. Syphilis and malaria contribute smaller numbers. Reducing stillbirths requires appropriate diagnosis and management of each condition, usually including hospital care for monitoring and delivery, often by caesarean section. Maternal syphilis and malaria were the only conditions for which outpatient management alone reduced stillbirth. CONCLUSIONS Most stillbirths in low-income countries occur at term and during labour and therefore are preventable by appropriate obstetric care. Management focused on the maternal and fetal conditions that cause stillbirths is necessary to achieve stillbirth rates approaching those found in high-income countries. TWEETABLE ABSTRACT Reducing stillbirth incidence requires appropriate management of each causative condition and often caesarean delivery.
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Affiliation(s)
- R L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA
| | - J B Griffin
- Statistical, Social and Environmental Health Sciences, RTI International, Durham, NC, USA
| | - B D Kamath-Rayne
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
| | - M Harrison
- Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA
| | - D J Rouse
- Statistical, Social and Environmental Health Sciences, RTI International, Durham, NC, USA
| | - K Moran
- Statistical, Social and Environmental Health Sciences, RTI International, Durham, NC, USA
| | - B Hepler
- Statistical, Social and Environmental Health Sciences, RTI International, Durham, NC, USA
| | - A H Jobe
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
| | - E M McClure
- Statistical, Social and Environmental Health Sciences, RTI International, Durham, NC, USA
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Reinebrant HE, Leisher SH, Coory M, Henry S, Wojcieszek AM, Gardener G, Lourie R, Ellwood D, Teoh Z, Allanson E, Blencowe H, Draper ES, Erwich JJ, Frøen JF, Gardosi J, Gold K, Gordijn S, Gordon A, Heazell A, Khong TY, Korteweg F, Lawn JE, McClure EM, Oats J, Pattinson R, Pettersson K, Siassakos D, Silver RM, Smith G, Tunçalp Ö, Flenady V. Making stillbirths visible: a systematic review of globally reported causes of stillbirth. BJOG 2017; 125:212-224. [PMID: 29193794 DOI: 10.1111/1471-0528.14971] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND Stillbirth is a global health problem. The World Health Organization (WHO) application of the International Classification of Diseases for perinatal mortality (ICD-PM) aims to improve data on stillbirth to enable prevention. OBJECTIVES To identify globally reported causes of stillbirth, classification systems, and alignment with the ICD-PM. SEARCH STRATEGY We searched CINAHL, EMBASE, Medline, Global Health, and Pubmed from 2009 to 2016. SELECTION CRITERIA Reports of stillbirth causes in unselective cohorts. DATA COLLECTION AND ANALYSIS Pooled estimates of causes were derived for country representative reports. Systems and causes were assessed for alignment with the ICD-PM. Data are presented by income setting (low, middle, and high income countries; LIC, MIC, HIC). MAIN RESULTS Eighty-five reports from 50 countries (489 089 stillbirths) were included. The most frequent categories were Unexplained, Antepartum haemorrhage, and Other (all settings); Infection and Hypoxic peripartum (LIC), and Placental (MIC, HIC). Overall report quality was low. Only one classification system fully aligned with ICD-PM. All stillbirth causes mapped to ICD-PM. In a subset from HIC, mapping obscured major causes. CONCLUSIONS There is a paucity of quality information on causes of stillbirth globally. Improving investigation of stillbirths and standardisation of audit and classification is urgently needed and should be achievable in all well-resourced settings. Implementation of the WHO Perinatal Mortality Audit and Review guide is needed, particularly across high burden settings. FUNDING HR, SH, SHL, and AW were supported by an NHMRC-CRE grant (APP1116640). VF was funded by an NHMRC-CDF (APP1123611). TWEETABLE ABSTRACT Urgent need to improve data on causes of stillbirths across all settings to meet global targets. PLAIN LANGUAGE SUMMARY Background and methods Nearly three million babies are stillborn every year. These deaths have deep and long-lasting effects on parents, healthcare providers, and the society. One of the major challenges to preventing stillbirths is the lack of information about why they happen. In this study, we collected reports on the causes of stillbirth from high-, middle-, and low-income countries to: (1) Understand the causes of stillbirth, and (2) Understand how to improve reporting of stillbirths. Findings We found 85 reports from 50 different countries. The information available from the reports was inconsistent and often of poor quality, so it was hard to get a clear picture about what are the causes of stillbirth across the world. Many different definitions of stillbirth were used. There was also wide variation in what investigations of the mother and baby were undertaken to identify the cause of stillbirth. Stillbirths in all income settings (low-, middle-, and high-income countries) were most frequently reported as Unexplained, Other, and Haemorrhage (bleeding). Unexplained and Other are not helpful in understanding why a baby was stillborn. In low-income countries, stillbirths were often attributed to Infection and Complications during labour and birth. In middle- and high-income countries, stillbirths were often reported as Placental complications. Limitations We may have missed some reports as searches were carried out in English only. The available reports were of poor quality. Implications Many countries, particularly those where the majority of stillbirths occur, do not report any information about these deaths. Where there are reports, the quality is often poor. It is important to improve the investigation and reporting of stillbirth using a standardised system so that policy makers and healthcare workers can develop effective stillbirth prevention programs. All stillbirths should be investigated and reported in line with the World Health Organization standards.
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Affiliation(s)
- H E Reinebrant
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, QLD, Australia.,International Stillbirth Alliance, Bristol, UK
| | - S H Leisher
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, QLD, Australia.,International Stillbirth Alliance, Bristol, UK
| | - M Coory
- Murdoch Childrens Research Institute, Melbourne, Vic., Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia
| | - S Henry
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, QLD, Australia.,International Stillbirth Alliance, Bristol, UK
| | - A M Wojcieszek
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, QLD, Australia.,International Stillbirth Alliance, Bristol, UK
| | - G Gardener
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, QLD, Australia.,International Stillbirth Alliance, Bristol, UK
| | - R Lourie
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, QLD, Australia.,Translational Research Institute, Brisbane, QLD, Australia
| | - D Ellwood
- Griffith University School of Medicine, Gold Coast, QLD, Australia.,Gold Coast University Hospital, Gold Coast, QLD, Australia
| | - Z Teoh
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, QLD, Australia.,Department of Medicine-Pediatrics, University of Louisville, Louisville, KY, USA
| | - E Allanson
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland.,School of Women's and Infants' Health, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, Perth, WA, Australia
| | - H Blencowe
- London School of Hygiene & Tropical Medicine, London, UK
| | - E S Draper
- MBRRACE-UK, Department of Health Sciences, University of Leicester Centre for Medicine, Leicester, UK
| | - J J Erwich
- International Stillbirth Alliance, Bristol, UK.,University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - J F Frøen
- Norwegian Institute of Public Health, Oslo, Norway.,Centre for Intervention Science in Maternal and Child Health (CISMAC), University of Bergen, Bergen, Norway
| | | | - K Gold
- International Stillbirth Alliance, Bristol, UK.,Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA.,Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - S Gordijn
- International Stillbirth Alliance, Bristol, UK.,University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - A Gordon
- University of Sydney, Sydney, NSW, Australia
| | - Aep Heazell
- Division of Developmental Biomedicine, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK.,St Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - T Y Khong
- SA Pathology, Women's and Children's Hospital, North Adelaide, SA, Australia
| | - F Korteweg
- Department of Obstetrics and Gynecology, Martini Hospital, Groningen, the Netherlands
| | - J E Lawn
- London School of Hygiene & Tropical Medicine, London, UK
| | - E M McClure
- International Stillbirth Alliance, Bristol, UK.,Department of Social, Statistical and Environmental Health Sciences, Research Triangle Institute, Research Triangle Park, NC, USA
| | - J Oats
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic., Australia.,Consultative Council on Obstetric and Paediatric Mortality and Morbidity (CCOPMM), Melbourne, Vic., Australia
| | - R Pattinson
- Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa
| | - K Pettersson
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - D Siassakos
- International Stillbirth Alliance, Bristol, UK.,Obstetrics and Gynaecology, School of Social and Community Medicine, Southmead Hospital, University of Bristol, Bristol, UK
| | - R M Silver
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Gcs Smith
- Department of Obstetrics and Gynaecology, NIHR Cambridge Comprehensive Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | - Ö Tunçalp
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - V Flenady
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, QLD, Australia.,International Stillbirth Alliance, Bristol, UK
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Identification of factors associated with stillbirth in the Indian state of Bihar using verbal autopsy: A population-based study. PLoS Med 2017; 14:e1002363. [PMID: 28763449 PMCID: PMC5538635 DOI: 10.1371/journal.pmed.1002363] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 06/19/2017] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND India was estimated to have the largest numbers of stillbirths globally in 2015, and the Indian government has adopted a target of <10 stillbirths per 1,000 births by 2030 through the India Newborn Action Plan (INAP). The objective of this study was to use verbal autopsy interviews to examine factors associated with stillbirth in the Indian state of Bihar and make recommendations for the INAP to better inform the setting of priorities and actions to reduce stillbirths. METHODS AND FINDINGS Verbal autopsy interviews were conducted for deaths including stillbirths that occurred from January 2011 to March 2014 in a sample of 109,689 households (87.1% participation) in 1,017 clusters representative of the state of Bihar. The Population Health Metrics Research Consortium shortened verbal autopsy questionnaire was used for each interview, and cause of death was assigned using the SmartVA automated algorithm. A stillbirth was defined as a foetal death with a gestation period of ≥28 weeks wherein the foetus did not show any sign of life. We report on the stillbirth epidemiology and present case studies from the qualitative data on the health provider interface that can be used to improve success of improved, skilled care at birth and delivery interventions. The annualised stillbirth incidence was 21.2 (95% CI 19.7 to 22.6) per 1,000 births, with it being higher in the rural areas. A total of 1,132 stillbirths were identified; 686 (62.2%) were boys, 327 (29.7%) were firstborn, and 760 (68.9%) were delivered at a health facility. Of all the stillbirths, 54.5% were estimated to be antepartum. Only 6,161 (55.9%) of the women reported at least 1 antenatal care visit, and 33% of the women reported not consuming the iron folic acid tablets during pregnancy. Significant differences were seen in delivery-related variables and associated maternal conditions based on the place of delivery and type of stillbirth. Only 6.1% of the women reported having undergone a test to rule out syphilis. For 34.2% of the stillbirths, the possible risk factor for stillbirth was unexplained. For the remaining 65.8% of the women who reported at least 1 complication during the last 3 months of pregnancy, maternal conditions including anaemia, fever during labour, and hypertension accounted for most of the complications. Of importance to note is that the maternal conditions overlapped quite significantly with the other possible underlying risk factors for stillbirth. Obstetrics complications and excessive bleeding during delivery contributed to nearly 30% of the cases as a possible risk factor for stillbirth, highlighting the need for better skilled care during delivery. Of the 5 major themes identified in open narratives, 3 were related to healthcare providers-lack of timely attention, poor skills (knowledge or implementation), and reluctance to deliver a dead baby. The case studies document the circumstances that highlight breakdowns in clinical care around the delivery or missed opportunities that can be used for improving the provision of quality skilled care. The main limitation of these data is that stillbirth is defined based on the gestation period and not based on birth weight; however, this is done in several studies from developing country settings in which birthweight is either not available or accurate. CONCLUSIONS To our knowledge, this study is among the few large, population-based assessments of stillbirths using verbal autopsy at the state level in India. These findings provide detailed insight into investigating the possible risk factors for stillbirths, as well as insight into the ground-level changes that are needed within the health system to design and implement effective preventive and intervention policies to reduce the burden of stillbirths. As most of the stillbirths are preventable with high-quality, evidence-based interventions delivered before and during pregnancy and during labour and childbirth, it is imperative that with INAP in place, India aspires to document stillbirths in a systematic and standardised manner to bridge the knowledge gap for appropriate actions to reduce stillbirths. We have made several recommendations based on our study that could further strengthen the INAP approach to improve the quality and quantity of stillbirth data to avoid this needless loss of lives.
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Altini M, Mullan P, Rooijakkers M, Gradl S, Penders J, Geusens N, Grieten L, Eskofier B. Detection of fetal kicks using body-worn accelerometers during pregnancy: Trade-offs between sensors number and positioning. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2016:5319-5322. [PMID: 28269461 DOI: 10.1109/embc.2016.7591928] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Monitoring fetal wellbeing is key in modern obstetrics. While fetal movement is routinely used as a proxy to fetal wellbeing, accurate, noninvasive, long-term monitoring of fetal movement is challenging. A few accelerometer-based systems have been developed in the past few years, to tackle common issues in ultrasound measurement and enable remote, self-administrated monitoring of fetal movement during pregnancy. However, many questions remain unanswered to date on the optimal setup in terms of body-worn accelerometers as well as signal processing and machine learning techniques used to detect fetal movement. In this paper, we systematically analyze the trade-offs between sensor number and positioning, the presence of reference accelerometers outside of the abdominal area and provide guidelines on dealing with class imbalance. Using a dataset of 15 measurements collected employing 6 three-axial accelerometers we show that including a reference accelerometer on the back of the participant consistently improves fetal movement detection performance regardless of the number of sensors utilized. We also show that two accelerometers plus a reference accelerometer are sufficient for optimal results.
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Sugai MK, Gilmour S, Ota E, Shibuya K. Trends in perinatal mortality and its risk factors in Japan: Analysis of vital registration data, 1979-2010. Sci Rep 2017; 7:46681. [PMID: 28440334 PMCID: PMC5404230 DOI: 10.1038/srep46681] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 03/27/2017] [Indexed: 01/21/2023] Open
Abstract
As Japan has achieved one of the lowest perinatal mortality rates (PMR), our study aims to estimate trends in and risk factors for perinatal mortality among singleton births in Japan. We used Japanese vital registration data to assess trends in and risk factors for perinatal outcomes between 1979 and 2010. Birth and death registration data were merged. An autoregressive integrated moving average model was fitted separately by sex to the PMR and the proportion of stillbirths. A multilevel Poisson regression model was used to estimate risk factors for perinatal mortality. Between 1979 and 2010 there were 40,833,957 pregnancies and 355,193 perinatal deaths, the PMR decreased from 18.86 per 1,000 all births to 3.25 per 1,000 all births, and the proportion of stillbirths increased from 83.6% to 92.1%. Key risk factors for perinatal mortality were low or high birth weight, prematurity and post maturity, and being from poorer or unemployed families. A higher proportion of excess perinatal deaths could be averted by effective policies to prevent stillbirths and improved research into their interventions and risk factors. As the cost and challenge of maintaining perinatal mortality gains increases, policies need to be targeted towards higher risk groups and social determinants of health.
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Affiliation(s)
- Maaya Kita Sugai
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Stuart Gilmour
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Erika Ota
- Global Health Nursing, Graduate School of Nursing Science, St. Luke’s International University, Tokyo, Japan
| | - Kenji Shibuya
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Millogo T, Ouédraogo GH, Baguiya A, Meda IB, Kouanda S, Sondo B. Factors associated with fresh stillbirths: A hospital-based, matched, case-control study in Burkina Faso. Int J Gynaecol Obstet 2017; 135 Suppl 1:S98-S102. [PMID: 27836094 DOI: 10.1016/j.ijgo.2016.08.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To determine the risk factors for fresh stillbirths in hospitals in Burkina Faso. METHODS A hospital-based, matched (1:1), case-control study was conducted from July to August 2014 in 50 hospitals across the country. All cases of stillbirth that occurred during this period in the participating facilities were included, and an appropriate control was selected for each case from the same health facility. Cases and controls were matched for gestational age. Conditional logistic regression with robust standard errors was used to compute both unadjusted and adjusted conditional odds ratios. RESULTS Cases were 67% less likely to have been delivered by a midwife compared with a nonmidwife attendant (ACOR=0.33; 95% CI, 0.12-0.84; P=0.02). Use of a partograph to monitor labor lowered the odds of fresh stillbirth by 82% (ACOR=0.18; 95% CI, 0.05-0.61; P=0.006). Mothers who had been transferred from another health facility were five times more likely to experience a fresh stillbirth (ACOR=5.36; 95% CI, 2.02-14.23; P<0.001). CONCLUSION Quality and timing of intrapartum obstetric care is key to preventing fresh stillbirths. Easy to implement and available interventions, such as use of a partograph for all laboring women and improving the referral system, have the potential to save the lives of many fetuses.
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Affiliation(s)
- Tieba Millogo
- African Institute of Public Health, Ouagadougou, Burkina Faso; Research Institute for Health Sciences, Ouagadougou, Burkina Faso.
| | | | - Adama Baguiya
- Research Institute for Health Sciences, Ouagadougou, Burkina Faso
| | | | - Seni Kouanda
- African Institute of Public Health, Ouagadougou, Burkina Faso; Research Institute for Health Sciences, Ouagadougou, Burkina Faso
| | - Blaise Sondo
- African Institute of Public Health, Ouagadougou, Burkina Faso; University of Ouagadougou, Ouagadougou, Burkina Faso
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Trudell AS, Tuuli MG, Colditz GA, Macones GA, Odibo AO. A stillbirth calculator: Development and internal validation of a clinical prediction model to quantify stillbirth risk. PLoS One 2017; 12:e0173461. [PMID: 28267756 PMCID: PMC5340400 DOI: 10.1371/journal.pone.0173461] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Accepted: 02/22/2017] [Indexed: 01/06/2023] Open
Abstract
Objective To generate a clinical prediction tool for stillbirth that combines maternal risk factors to provide an evidence based approach for the identification of women who will benefit most from antenatal testing for stillbirth prevention. Design Retrospective cohort study Setting Midwestern United States quaternary referral center Population Singleton pregnancies undergoing second trimester anatomic survey from 1999–2009. Pregnancies with incomplete follow-up were excluded. Methods Candidate predictors were identified from the literature and univariate analysis. Backward stepwise logistic regression with statistical comparison of model discrimination, calibration and clinical performance was used to generate final models for the prediction of stillbirth. Internal validation was performed using bootstrapping with 1,000 repetitions. A stillbirth risk calculator and stillbirth risk score were developed for the prediction of stillbirth at or beyond 32 weeks excluding fetal anomalies and aneuploidy. Statistical and clinical cut-points were identified and the tools compared using the Integrated Discrimination Improvement. Main outcome measures Antepartum stillbirth Results 64,173 women met inclusion criteria. The final stillbirth risk calculator and score included maternal age, black race, nulliparity, body mass index, smoking, chronic hypertension and pre-gestational diabetes. The stillbirth calculator and simple risk score demonstrated modest discrimination but clinically significant performance with no difference in overall performance between the tools [(AUC 0.66 95% CI 0.60–0.72) and (AUC 0.64 95% CI 0.58–0.70), (p = 0.25)]. Conclusion A stillbirth risk score was developed incorporating maternal risk factors easily ascertained during prenatal care to determine an individual woman’s risk for stillbirth and provide an evidenced based approach to the initiation of antenatal testing for the prediction and prevention of stillbirth.
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Affiliation(s)
- Amanda S. Trudell
- Mercy Hospital St. Louis Department of Obstetrics and Gynecology, Midwest Maternal Fetal Medicine, St. Louis, Missouri, United States of America
- * E-mail:
| | - Methodius G. Tuuli
- Washington University School of Medicine Department of Obstetrics and Gynecology Division of Maternal Fetal Medicine, St. Louis, Missouri, United States of America
| | - Graham A. Colditz
- Washington University School of Medicine Department of Surgery Division of Public Health, St. Louis, Missouri, United States of America
| | - George A. Macones
- Washington University School of Medicine Department of Obstetrics and Gynecology Division of Maternal Fetal Medicine, St. Louis, Missouri, United States of America
| | - Anthony O. Odibo
- University of South Florida, Moorsani College of Medicine Department of Obstetrics and Gynecology Division of Maternal Fetal Medicine, Tampa, Florida, United States of America
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Amegah AK, Näyhä S, Jaakkola JJK. Do biomass fuel use and consumption of unsafe water mediate educational inequalities in stillbirth risk? An analysis of the 2007 Ghana Maternal Health Survey. BMJ Open 2017; 7:e012348. [PMID: 28174221 PMCID: PMC5306511 DOI: 10.1136/bmjopen-2016-012348] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Numerous studies have explored the association between educational inequalities and stillbirth but most have failed to elaborate how low educational attainment leads to an increased risk of stillbirth. We hypothesised that use of biomass fuels and consumption of unsafe water related to low educational attainment could explain the stillbirth burden in Ghana attributable to socioeconomic disadvantage. METHODS Data from the 2007 Ghana Maternal Health Survey, a nationally representative population-based survey were analysed for this study. Of the10 370 women aged 15-49 years interviewed via structured questionnaires for the survey, 7183 primiparous and multiparous women qualified for inclusion in the present study. RESULTS In a logistic regression analysis that adjusted for age, area of residence, marital status and ethnicity of women, lower maternal primary education was associated with a 62% (OR=1.62; 95% CI 1.04 to 2.52) increased lifetime risk of stillbirth. Biomass fuel use and consumption of unsafe water mediated 18% and 8% of the observed effects, respectively. Jointly these two exposures explained 24% of the observed effects. The generalised additive modelling revealed a very flat inverted spoon-shaped smoothed curve which peaked at low levels of schooling (2-3 years) and confirms the findings from the logistic regression analysis. CONCLUSIONS Our results show that biomass fuel use and unsafe water consumption could be important pathways through which low maternal educational attainment leads to stillbirths in Ghana and similar developing countries. Addressing educational inequalities in developing countries is thus essential for ensuring household choices that curtail environmental exposures and help improve pregnancy outcomes.
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Affiliation(s)
- A Kofi Amegah
- Public Health Research Group, Department of Biomedical Sciences, School of Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Simo Näyhä
- Center for Environmental and Respiratory Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Jouni J K Jaakkola
- Center for Environmental and Respiratory Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
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Shorey S, André B, Lopez V. The experiences and needs of healthcare professionals facing perinatal death: A scoping review. Int J Nurs Stud 2016; 68:25-39. [PMID: 28063339 DOI: 10.1016/j.ijnurstu.2016.12.007] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 12/13/2016] [Accepted: 12/15/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND Globally, perinatal death is on a decline. However, its impact on the healthcare profession is huge. The existing literature focuses on examining perinatal death from parents' perspectives and patient death from the perspectives of nurses and a few doctors in critical care, oncology, and neonatology in the West. Due to the unique setting of maternity units where death is not routinely anticipated, as well as distinctive socio-cultural views surrounding death, there is a need to comprehensively review literature examining the impact of perinatal death on the perspectives of healthcare professionals working in maternity units. OBJECTIVES To examine available literature on the needs and experiences of healthcare professionals working in maternity units who have experienced perinatal death. DESIGN A scoping review of published and unpublished data. DATA SOURCES A systematic literature search from 1st January 1996 to 5th August 2016 was made in the following databases: PubMed, CINAHL, Embase, PsycINFO, ScienceDirect, and Web of Science. Cochrane Library, Joanna Briggs Institute Library of Systematic Reviews, York Centre for Reviews and Dissemination, Open Grey, ProQuest Dissertation and Theses, and Mednar were reviewed for grey literature. A hand search of the reference lists of the included papers was performed. REVIEW METHODS Based on the pre-set inclusion criteria, 1519 articles were screened for their titles and abstracts. Eighty-five full-text papers were reviewed, resulting in 30 papers included for this review. The data were extracted and cross-checked between the reviewers. Any discrepancy between the authors' views would be discussed with a third reviewer until consensus was reached. Thematic analysis was used to categorise the results into themes. RESULTS Two major themes emerged from the review: the experiences and needs of healthcare professionals. Six subthemes emerged from the experiences of healthcare professionals: 1) psychological impact, 2) physical impact, 3) positive feelings, 4) coping strategies, 5) personal factors influencing the experience, and 6) cultural factors influencing the experience. Three subthemes including 1) social support, 2) training and education, and 3) other needs explained the needs of healthcare professionals. Studies focusing on the experiences and needs of physicians were scarce. CONCLUSIONS Perinatal death has a profound impact on the psychological and physical wellbeing of healthcare professionals. They have unmet needs that need to be addressed. Though they use internal and external resources to combat their stress, institutional support acknowledging their stress and their needs is essential. Culturally-sensitive education and training are needed to provide support to these professionals.
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Affiliation(s)
- Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Level 2, Clinical Research Centre, Block MD 11, 10 Medical Drive, Singapore.
| | - Beate André
- Faculty of Nursing- Centre for Health Promotion Research, NTNU- Norwegian University of Science and Technology, 7491 Trondheim, Norway.
| | - Violeta Lopez
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Level 2, Clinical Research Centre, Block MD 11, 10 Medical Drive, Singapore.
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Leisher SH, Teoh Z, Reinebrant H, Allanson E, Blencowe H, Erwich JJ, Frøen JF, Gardosi J, Gordijn S, Gülmezoglu AM, Heazell AEP, Korteweg F, Lawn J, McClure EM, Pattinson R, Smith GCS, Tunçalp Ӧ, Wojcieszek AM, Flenady V. Seeking order amidst chaos: a systematic review of classification systems for causes of stillbirth and neonatal death, 2009-2014. BMC Pregnancy Childbirth 2016; 16:295. [PMID: 27716090 PMCID: PMC5053068 DOI: 10.1186/s12884-016-1071-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 09/07/2016] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Each year, about 5.3 million babies die in the perinatal period. Understanding of causes of death is critical for prevention, yet there is no globally acceptable classification system. Instead, many disparate systems have been developed and used. We aimed to identify all systems used or created between 2009 and 2014, with their key features, including extent of alignment with the International Classification of Diseases (ICD) and variation in features by region, to inform the World Health Organization's development of a new global approach to classifying perinatal deaths. METHODS A systematic literature review (CINAHL, EMBASE, Medline, Global Health, and PubMed) identified published and unpublished studies and national reports describing new classification systems or modifications of existing systems for causes of perinatal death, or that used or tested such systems, between 2009 and 2014. Studies reporting ICD use only were excluded. Data were independently double-extracted (except from non-English publications). Subgroup analyses explored variation by extent and region. RESULTS Eighty-one systems were identified as new, modifications of existing systems, or having been used between 2009 and 2014, with an average of ten systems created/modified each year. Systems had widely varying characteristics: (i) comprehensiveness (40 systems classified both stillbirths and neonatal deaths); (ii) extent of use (systems were created in 28 countries and used in 40; 17 were created for national use; 27 were widely used); (iii) accessibility (three systems available in e-format); (iv) underlying cause of death (64 systems required a single cause of death); (v) reliability (10 systems tested for reliability, with overall Kappa scores ranging from .35-.93); and (vi) ICD alignment (17 systems used ICD codes). Regional databases were not searched, so system numbers may be underestimated. Some non-differential misclassification of systems was possible. CONCLUSIONS The plethora of systems in use, and continuing system development, hamper international efforts to improve understanding of causes of death. Recognition of the features of currently used systems, combined with a better understanding of the drivers of continued system creation, may help the development of a truly effective global system.
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Affiliation(s)
- Susannah Hopkins Leisher
- Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, Australia.
- International Stillbirth Alliance, Millburn, USA.
| | - Zheyi Teoh
- Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, Australia
| | - Hanna Reinebrant
- Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, Australia
- International Stillbirth Alliance, Millburn, USA
| | - Emma Allanson
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
- School of Women's and Infants' Health, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, Perth, Australia
| | | | - Jan Jaap Erwich
- International Stillbirth Alliance, Millburn, USA
- The University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - J Frederik Frøen
- Department of International Public Health, Norwegian Institute of Public Health, Oslo, Norway
- Center for Intervention Science for Maternal and Child Health, University of Bergen, Bergen, Norway
| | | | - Sanne Gordijn
- International Stillbirth Alliance, Millburn, USA
- The University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - A Metin Gülmezoglu
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Alexander E P Heazell
- International Stillbirth Alliance, Millburn, USA
- Maternal and Fetal Health Research Centre, University of Manchester, Manchester, UK
- St. Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Fleurisca Korteweg
- International Stillbirth Alliance, Millburn, USA
- Department of Obstetrics and Gynaecology, Martini Hospital, Groningen, The Netherlands
| | - Joy Lawn
- London School of Hygiene & Tropical Medicine, London, UK
| | - Elizabeth M McClure
- International Stillbirth Alliance, Millburn, USA
- Research Triangle Institute, North Carolina, USA
| | - Robert Pattinson
- South Africa Medical Research Council Maternal and Infant Health Care Strategies Unit, University of Pretoria, Pretoria, South Africa
| | - Gordon C S Smith
- NIHR Biomedical Research Centre & Department of Obstetrics & Gynaecology, Cambridge University, Cambridge, UK
| | - Ӧzge Tunçalp
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Aleena M Wojcieszek
- Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, Australia
- International Stillbirth Alliance, Millburn, USA
| | - Vicki Flenady
- Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, Australia
- International Stillbirth Alliance, Millburn, USA
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Kayode GA, Grobbee DE, Amoakoh-Coleman M, Adeleke IT, Ansah E, de Groot JAH, Klipstein-Grobusch K. Predicting stillbirth in a low resource setting. BMC Pregnancy Childbirth 2016; 16:274. [PMID: 27649795 PMCID: PMC5029011 DOI: 10.1186/s12884-016-1061-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Accepted: 09/06/2016] [Indexed: 12/23/2022] Open
Abstract
Background Stillbirth is a major contributor to perinatal mortality and it is particularly common in low- and middle-income countries, where annually about three million stillbirths occur in the third trimester. This study aims to develop a prediction model for early detection of pregnancies at high risk of stillbirth. Methods This retrospective cohort study examined 6,573 pregnant women who delivered at Federal Medical Centre Bida, a tertiary level of healthcare in Nigeria from January 2010 to December 2013. Descriptive statistics were performed and missing data imputed. Multivariable logistic regression was applied to examine the associations between selected candidate predictors and stillbirth. Discrimination and calibration were used to assess the model’s performance. The prediction model was validated internally and over-optimism was corrected. Results We developed a prediction model for stillbirth that comprised maternal comorbidity, place of residence, maternal occupation, parity, bleeding in pregnancy, and fetal presentation. As a secondary analysis, we extended the model by including fetal growth rate as a predictor, to examine how beneficial ultrasound parameters would be for the predictive performance of the model. After internal validation, both calibration and discriminative performance of both the basic and extended model were excellent (i.e. C-statistic basic model = 0.80 (95 % CI 0.78–0.83) and extended model = 0.82 (95 % CI 0.80–0.83)). Conclusion We developed a simple but informative prediction model for early detection of pregnancies with a high risk of stillbirth for early intervention in a low resource setting. Future research should focus on external validation of the performance of this promising model. Electronic supplementary material The online version of this article (doi:10.1186/s12884-016-1061-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gbenga A Kayode
- Julius Global Health, Julius Center for Health Sciences and Primary Care
- University Medical Centre Utrecht, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands.
| | - Diederick E Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care
- University Medical Centre Utrecht, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands.,Global Geo and Health Data Center, Utrecht University, Utrecht, Netherlands
| | - Mary Amoakoh-Coleman
- Julius Global Health, Julius Center for Health Sciences and Primary Care
- University Medical Centre Utrecht, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands
| | | | - Evelyn Ansah
- Ghana Health Service, Greater Accra Region, Accra, Ghana
| | - Joris A H de Groot
- Julius Global Health, Julius Center for Health Sciences and Primary Care
- University Medical Centre Utrecht, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care
- University Medical Centre Utrecht, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands.,Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Science, University of Witwatersrand, Johannesburg, South Africa.,Global Geo and Health Data Center, Utrecht University, Utrecht, Netherlands
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Berhie KA, Gebresilassie HG. Logistic regression analysis on the determinants of stillbirth in Ethiopia. Matern Health Neonatol Perinatol 2016; 2:10. [PMID: 27660718 PMCID: PMC5025573 DOI: 10.1186/s40748-016-0038-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Accepted: 09/08/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Stillbirth is often defined as fetal death after 24 weeks of gestation, but a fetus greater than any combination of 16, 20, 22, 24, or 28 weeks gestational age and 350 g, 400 g, 500 g, or 1000 g birth weight may be considered stillborn depending on local law. Once the fetus has died, the mother may or may not have contractions and undergo childbirth or in some cases, a Caesarean section. Most stillbirths occur in full-term pregnancies. METHODS This study has intended to model determinants of experiencing stillbirth among women in child bearing age group of Ethiopia using the Ethiopian demographic and health Survey data (EDHS, 2011). First, the bivariate chi-square test of association was fitted to the data and significant variables were considered for further investigation binary logistic regression models were fitted. RESULTS This study revealed that the rate of experiencing stillbirth among women of child bearing age was about 25.5 per 1000 deliveries in Ethiopia. From binary logistic regression, region of residence, maternal age, place of residence, education level, parity, antenatal care utilization, place of delivery, body mass index (BMI) and anemia level were found to be significantly associated with experiencing stillbirth. CONCLUSIONS Researchers should use multilevel models than traditional regression methods when their data structure is hierarchical as like in Ethiopian Demographic and Health Survey data.
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Affiliation(s)
- Kidanemariam Alem Berhie
- Department of Statistics, College of Natural and Computational Sciences, University of Gondar, Gondar, Ethiopia
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Post-mortem magnetic resonance foetal imaging: a study of morphological correlation with conventional autopsy and histopathological findings. Radiol Med 2016; 121:847-856. [PMID: 27465122 DOI: 10.1007/s11547-016-0672-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 07/18/2016] [Indexed: 12/19/2022]
Abstract
The aim of the present study is to offer our experience concerning post-mortem magnetic resonance (PMMR) in foetal death cases and an evaluation of the differences between the findings acquired by PMMR and by forensic autopsy. Fifteen foetuses were recruited from July 2014 to December 2015. These had suffered intrauterine death in women in the 21st to 38th week of gestation who were treated in the emergency department for non-perception of foetal movements. We performed a PMMR on foetuses, 3 ± 1 days on average from the time of death, and then a complete forensic autopsy was performed. All 15 foetuses were examined with a whole-body study protocol, starting from the skull, down to and including the lower limbs. The total time of examination ranged from 20 to 30 min in each case. The external evaluation and description of post-mortem phenomena (maceration), record of the weight and detection and the various measurements of foetal diameters were evaluated before performing autopsy. A complete histopathological study was performed in each case. Out of 15 cases examined, eight were negative for structural anatomical abnormalities and/or diseases, both in the preliminary radiological examination and the traditional autopsy. In the remaining seven cases, pathological findings were detected by PMMR with corresponding results at autopsy. PMMR can provide useful information on foetal medical conditions and result in improved diagnostic classification. It may enable the planning of a more suitable technique before proceeding to autopsy, including focusing on certain aspects of organ pathology otherwise not detectable. The association between PMMR, post-mortem examination and related histological study of the foetus-placenta unit could help reduce the percentage of cases in which the cause of foetal death remains unexplained. Lastly, it may allow a selective sampling of the organ in order to target histological investigations.
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Contag S, Brown C, Crimmins S, Goetzinger K. Influence of Birthweight on the Prospective Stillbirth Risk in the Third Trimester: A Cross-Sectional Cohort Study. AJP Rep 2016; 6:e287-98. [PMID: 27540493 PMCID: PMC4988848 DOI: 10.1055/s-0036-1587322] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The objective of this study was to determine the effect of birthweight on prospective stillbirth risk. METHODS Cross-sectional study of singleton births in the United States from 2010 to 2012 from 32 through 42 weeks was conducted. Stillbirth risk was stratified by birthweight and gestational age adjusted for time from death to delivery. The primary outcome was the prospective stillbirth risk for each birthweight category. Student t-test was used for continuous data, chi-square to compare categorical data. Binomial proportions were used to derive prospective and cumulative risks. Cox proportional hazards regression with log-rank test comparison for heterogeneity was used to compare birthweight categories and derive hazard ratios. RESULTS There was an increase in the risk for stillbirth as birthweight diverged from the reference group. At 40 weeks adjusted gestational age, stillbirth rate per 10,000 births for the bottom (6.17, 95% CI: 7.47-4.87) and top (2.37, 95%CI: 3.1-1.65) 5th centiles of birthweight conveyed the highest risk. Hazard ratios (HR) after adjusting for covariates were: 1.55 (1.73-1.4) <5th centile and 2.2 (2.43-1.99) > 95th centile (p < 0.001). CONCLUSION Stillbirth risk increases as birthweight departs from the mean. Birthweight below the 5th and above the 95th centile conveyed a significantly increased risk for stillbirth which was most noticeable after 37 weeks.
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Affiliation(s)
- Stephen Contag
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, Maryland
| | - Clayton Brown
- Department of Epidemiology and Public Health, University of Maryland, Baltimore, Maryland
| | - Sarah Crimmins
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, Maryland
| | - Katherine Goetzinger
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, Maryland
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Murguía-Peniche T, Illescas-Zárate D, Chico-Barba G, Bhutta ZA. An ecological study of stillbirths in Mexico from 2000 to 2013. Bull World Health Organ 2016; 94:322-330A. [PMID: 27147762 PMCID: PMC4850527 DOI: 10.2471/blt.15.154922] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 02/09/2016] [Accepted: 02/09/2016] [Indexed: 11/27/2022] Open
Abstract
Objective To examine trends in the rate of stillbirths at or after 21 weeks’ gestation in Mexico from 2000 to 2013, identify factors associated with stillbirths and estimate subnational variability in stillbirth rates and the proportion of deaths occurring intrapartum. Methods This population-based, ecological study involved data from a national database on 263 475 stillbirths in 29 Mexican states and maternal sociodemographic factors. Subnational variability in the stillbirth rate in 2012 was investigated and stillbirths in 2013 were categorized as intrapartum or antepartum according to the fetus’ skin condition. Findings The national stillbirth rate declined from 9.2 to 7.2 per 1000 births between 2000 and 2013 (i.e. −1.9% per year). The prevalence of stillbirths varied 3.9-fold between states. Stillbirths were associated, in particular, with: residence in Mexico City (odds ratio, OR: 1.71; 95% confidence interval, CI: 1.68–1.73) or central Mexico (OR: 1.36; 95% CI: 1.34–1.38); maternal education of 9 years or less (OR:1.10; 95% CI: 1.08–1.11) or 10 to 12 years (OR: 1.16; 95% CI: 1.14–1.18); mothers younger than 15 years (OR: 1.64; 95% CI: 1.55–1.72) or older than 34 years (OR: 1.68; 95% CI: 1.66–1.70); and male fetal sex (OR: 1.20; 95% CI: 1.19–1.21). Overall, 51% (7348/14 344) of fetal deaths occurred intrapartum. Conclusion In Mexico, the total stillbirth rate declined between 2000 and 2013, however geographical variations were observed. Stillbirths were associated with sociodemographic factors. The proportion of intrapartum stillbirths was relatively high, suggesting that health system performance could be improved, especially at places of delivery.
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Affiliation(s)
- Teresa Murguía-Peniche
- Faculty of Health Sciences, School of Medicine, Universidad Panamericana, Donatello 59, Colonia Insurgentes Mixcoac, Mexico City, 03920, Mexico
| | - Daniel Illescas-Zárate
- Research Division Community Interventions, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Gabriela Chico-Barba
- Research Division Community Interventions, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Zulfiqar A Bhutta
- Center for Global Child Health, Hospital for Sick Children, Toronto, Canada
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Adachi K, Nielsen-Saines K, Klausner JD. Chlamydia trachomatis Infection in Pregnancy: The Global Challenge of Preventing Adverse Pregnancy and Infant Outcomes in Sub-Saharan Africa and Asia. BIOMED RESEARCH INTERNATIONAL 2016; 2016:9315757. [PMID: 27144177 PMCID: PMC4837252 DOI: 10.1155/2016/9315757] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 02/09/2016] [Indexed: 12/28/2022]
Abstract
Screening and treatment of sexually transmitted infections (STIs) in pregnancy represents an overlooked opportunity to improve the health outcomes of women and infants worldwide. Although Chlamydia trachomatis is the most common treatable bacterial STI, few countries have routine pregnancy screening and treatment programs. We reviewed the current literature surrounding Chlamydia trachomatis in pregnancy, particularly focusing on countries in sub-Saharan Africa and Asia. We discuss possible chlamydial adverse pregnancy and infant health outcomes (miscarriage, stillbirth, ectopic pregnancy, preterm birth, neonatal conjunctivitis, neonatal pneumonia, and other potential effects including HIV perinatal transmission) and review studies of chlamydial screening and treatment in pregnancy, while simultaneously highlighting research from resource-limited countries in sub-Saharan Africa and Asia.
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Affiliation(s)
- Kristina Adachi
- Department of Pediatrics, David Geffen School of Medicine, UCLA, Los Angeles, CA 90024, USA
| | - Karin Nielsen-Saines
- Department of Pediatrics, David Geffen School of Medicine, UCLA, Los Angeles, CA 90024, USA
| | - Jeffrey D. Klausner
- Department of Medicine, Division of Infectious Diseases: Global Health, David Geffen School of Medicine, UCLA, Los Angeles, CA 90024, USA
- Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, UCLA, Los Angeles, CA 90024, USA
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Roberts L, Montgomery S. Mindfulness-based Intervention for Perinatal Grief Education and Reduction among Poor Women in Chhattisgarh, India: a Pilot Study. INTERDISCIPLINARY JOURNAL OF BEST PRACTICES IN GLOBAL DEVELOPMENT 2016; 2:1. [PMID: 28357415 PMCID: PMC5367631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Stillbirth is a significant public health problem in low-to-middle-income countries and results in perinatal grief, often with negative psychosocial impact. In low-resource settings, such as Chhattisgarh, India, where needs are high, it is imperative to utilize low-cost, effective interventions. Mindfulness-based stress reduction (MBSR) is an empirically sound intervention that has been utilized for a broad range of physical and mental health problems, and is adaptable to specific populations. The main objective of this pilot study was to explore the feasibility and effectiveness of a shortened, culturally adapted mindfulness-based intervention to address complex grief after stillbirth. METHODS We used an observational, pre-post-6-week post study design. The study instrument was made up of descriptive demographic questions and validated scales and was administered as a structured interview due to low literacy rates. We used a community participatory approach to culturally adapt the five-week mindfulness-based intervention and delivered it through two trained local nurses. Quantitative and qualitative data analyses explored study outcomes as well as acceptability and feasibility of the intervention. RESULTS 29 women with a history of stillbirth enrolled, completed the pretest and began the intervention; 26 completed the five-week intervention and post-test (89.7%), and 23 completed the six-week follow-up assessment (88.5%). Pretest results included elevated psychological symptoms and high levels of perinatal grief, including the active grief, difficulty coping, and despair subscales. General linear modeling repeated measures was used to explore posttest and six-week follow up changes from baseline, controlling for significantly correlated demographic variables. These longitudinal results included significant reduction in psychological symptoms; four of the five facets of mindfulness changed in the desired direction, two significantly; as well as significant reduction in overall perinatal grief and on each of the three subscales. DISCUSSION The shortened, culturally adapted, mindfulness-based intervention pilot study was well received and had very low attrition. We also found significant reductions of perinatal grief and mental health symptoms over time, as well as a high degree of practice of mindfulness skills by participants. This study not only sheds light on the tremendous mental health needs among rural women of various castes who have experienced stillbirth in Chhattisgarh, it also points to a promising effective intervention with potential to be taken to scale for wider delivery.
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Perinatal Disparities Between American Indians and Alaska Natives and Other US Populations: Comparative Changes in Fetal and First Day Mortality, 1995-2008. Matern Child Health J 2016; 19:1802-12. [PMID: 25663653 DOI: 10.1007/s10995-015-1694-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
To compare fetal and first day outcomes of American Indian and Alaskan Natives (AIAN) with non-AIAN populations. Singleton deliveries to AIAN and non-AIAN populations were selected from live birth-infant death cohort and fetal deaths files from 1995-1998 and 2005-2008. We examined changes over time in maternal characteristics of deliveries and disparities and changes in risks of fetal, first day (<24 h), and cause-specific deaths. We calculated descriptive statistics, odds ratios and confidence intervals, and ratio of odds ratios (RORs) to indicate changes in disparities. Along with black mothers, AIANs exhibited the highest proportion of risk factors including the highest proportion of diabetes in both time periods (4.6 and 6.5 %). Over time, late fetal death for AIANs decreased 17 % (aOR = 0.83, 95 % CI 0.72-0.97), but we noted a 47 % increased risk over time for Hispanics (aOR = 1.47, 95 % CI 1.40-1.55). Our data indicated no change over time among AIANs for first day death. For AIANs compared to whites, increased risks and disparities persisted for mortality due to congenital anomalies (ROR = 1.28, 95 % CI 1.03-1.60). For blacks compared to AIANs, the increased risks of fetal death (2005-2008: aOR = 0.60, 95 % CI 0.53-0.68) persisted. For Hispanics, lower risks compared to AIANs persisted, but protective effect declined over time. Disparities between AIAN and other groups persist, but there is variability by race/ethnicity in improvement of perinatal outcomes over time. Variability in access to care and pregnancy management should be considered in relation to health equity for fetal and early infant deaths.
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Field D, Boyle E, Draper E, Evans A, Johnson S, Khan K, Manktelow B, Marlow N, Petrou S, Pritchard C, Seaton S, Smith L. Towards reducing variations in infant mortality and morbidity: a population-based approach. PROGRAMME GRANTS FOR APPLIED RESEARCH 2016. [DOI: 10.3310/pgfar04010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BackgroundOur aims were (1) to improve understanding of regional variation in early-life mortality rates and the UK’s poor performance in international comparisons; and (2) to identify the extent to which late and moderately preterm (LMPT) birth contributes to early childhood mortality and morbidity.ObjectiveTo undertake a programme of linked population-based research studies to work towards reducing variations in infant mortality and morbidity rates.DesignTwo interlinked streams: (1) a detailed analysis of national and regional data sets and (2) establishment of cohorts of LMPT babies and term-born control babies.SettingCohorts were drawn from the geographically defined areas of Leicestershire and Nottinghamshire, and analyses were carried out at the University of Leicester.Data sourcesFor stream 1, national data were obtained from four sources: the Office for National Statistics, NHS Numbers for Babies, Centre for Maternal and Child Enquiries and East Midlands and South Yorkshire Congenital Anomalies Register. For stream 2, prospective data were collected for 1130 LMPT babies and 1255 term-born control babies.Main outcome measuresDetailed analysis of stillbirth and early childhood mortality rates with a particular focus on factors leading to biased or unfair comparison; review of clinical, health economic and developmental outcomes over the first 2 years of life for LMPT and term-born babies.ResultsThe deprivation gap in neonatal mortality has widened over time, despite government efforts to reduce it. Stillbirth rates are twice as high in the most deprived as in the least deprived decile. Approximately 70% of all infant deaths are the result of either preterm birth or a major congenital abnormality, and these are heavily influenced by mothers’ exposure to deprivation. Births at < 24 weeks’ gestation constitute only 1% of all births, but account for 20% of infant mortality. Classification of birth status for these babies varies widely across England. Risk of LMPT birth is greatest in the most deprived groups within society. Compared with term-born peers, LMPT babies are at an increased risk of neonatal morbidity, neonatal unit admission and poorer long-term health and developmental outcomes. Cognitive and socioemotional development problems confer the greatest long-term burden, with the risk being amplified by socioeconomic factors. During the first 24 months of life each child born LMPT generates approximately £3500 of additional health and societal costs.ConclusionsHealth professionals should be cautious in reviewing unadjusted early-life mortality rates, particularly when these relate to individual trusts. When more sophisticated analysis is not possible, babies of < 24 weeks’ gestation should be excluded. Neonatal services should review the care they offer to babies born LMPT to ensure that it is appropriate to their needs. The risk of adverse outcome is low in LMPT children. However, the risk appears higher for some types of antenatal problems and when the mother is from a deprived background.Future workFuture work could include studies to improve our understanding of how deprivation increases the risk of mortality and morbidity in early life and investigation of longer-term outcomes and interventions in at-risk LMPT infants to improve future attainment.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.
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Affiliation(s)
- David Field
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Elaine Boyle
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Elizabeth Draper
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Alun Evans
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Samantha Johnson
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Kamran Khan
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Bradley Manktelow
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Neil Marlow
- Institute for Women’s Health, University College London, London, UK
| | - Stavros Petrou
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Sarah Seaton
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Lucy Smith
- Department of Health Sciences, University of Leicester, Leicester, UK
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de Bernis L, Kinney MV, Stones W, Ten Hoope-Bender P, Vivio D, Leisher SH, Bhutta ZA, Gülmezoglu M, Mathai M, Belizán JM, Franco L, McDougall L, Zeitlin J, Malata A, Dickson KE, Lawn JE. Stillbirths: ending preventable deaths by 2030. Lancet 2016; 387:703-716. [PMID: 26794079 DOI: 10.1016/s0140-6736(15)00954-x] [Citation(s) in RCA: 243] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Efforts to achieve the new worldwide goals for maternal and child survival will also prevent stillbirth and improve health and developmental outcomes. However, the number of annual stillbirths remains unchanged since 2011 and is unacceptably high: an estimated 2.6 million in 2015. Failure to consistently include global targets or indicators for stillbirth in post-2015 initiatives shows that stillbirths are hidden in the worldwide agenda. This Series paper summarises findings from previous papers in this Series, presents new analyses, and proposes specific criteria for successful integration of stillbirths into post-2015 initiatives for women's and children's health. Five priority areas to change the stillbirth trend include intentional leadership; increased voice, especially of women; implementation of integrated interventions with commensurate investment; indicators to measure effect of interventions and especially to monitor progress; and investigation into crucial knowledge gaps. The post-2015 agenda represents opportunities for all stakeholders to act together to end all preventable deaths, including stillbirths.
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Affiliation(s)
| | - Mary V Kinney
- Save the Children, Saving Newborn Lives, Edgemead, South Africa
| | - William Stones
- University of St Andrews, School of Medicine, North Haugh, St Andrews, UK; Department of Obstetrics and Gynaecology, University of Malawi, Blantyre, Malawi; International Federation of Gynecology and Obstetrics, London, UK
| | | | - Donna Vivio
- Global Health Bureau, US Agency for International Development, Washington, DC, USA
| | - Susannah Hopkins Leisher
- Mater Research Institute, University of Queensland, St Lucia, QLD, Australia; International Stillbirth Alliance, NJ, USA
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada; Center of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan; International Paediatric Association, World Health Organization, Geneva, Switzerland
| | - Metin Gülmezoglu
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Matthews Mathai
- Department of Maternal, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Jose M Belizán
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | | | - Lori McDougall
- Partnership for Maternal, Newborn and Child Health, Geneva, Switzerland
| | - Jennifer Zeitlin
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics, Sorbonne Paris Cité, Paris Descartes University, Paris, France
| | - Address Malata
- Kamuzu College of Nursing University of Malawi, Lilongwe, Malawi
| | - Kim E Dickson
- Programmes Division, UNICEF Headquarters, New York, NY, USA
| | - Joy E Lawn
- The Centre for Maternal, Adolescent, Reproductive and Child Health (MARCH) and Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Saving Newborn Lives, Save the Children, Washington, DC, USA
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71
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Frøen JF, Friberg IK, Lawn JE, Bhutta ZA, Pattinson RC, Allanson ER, Flenady V, McClure EM, Franco L, Goldenberg RL, Kinney MV, Leisher SH, Pitt C, Islam M, Khera A, Dhaliwal L, Aggarwal N, Raina N, Temmerman M. Stillbirths: progress and unfinished business. Lancet 2016; 387:574-586. [PMID: 26794077 DOI: 10.1016/s0140-6736(15)00818-1] [Citation(s) in RCA: 119] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
This first paper of the Lancet Series on ending preventable stillbirths reviews progress in essential areas, identified in the 2011 call to action for stillbirth prevention, to inform the integrated post-2015 agenda for maternal and newborn health. Worldwide attention to babies who die in stillbirth is rapidly increasing, from integration within the new Global Strategy for Women's, Children's and Adolescents' Health, to country policies inspired by the Every Newborn Action Plan. Supportive new guidance and metrics including stillbirth as a core health indicator and measure of quality of care are emerging. Prenatal health is a crucial biological foundation to life-long health. A key priority is to integrate action for prenatal health within the continuum of care for maternal and newborn health. Still, specific actions for stillbirths are needed for advocacy, policy formulation, monitoring, and research, including improvement in the dearth of data for effective coverage of proven interventions for prenatal survival. Strong leadership is needed worldwide and in countries. Institutions with a mandate to lead global efforts for mothers and their babies must assert their leadership to reduce stillbirths by promoting healthy and safe pregnancies.
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Affiliation(s)
- J Frederik Frøen
- Department of International Public Health, Norwegian Institute of Public Health, Oslo, Norway; Center for Intervention Science for Maternal and Child Health, University of Bergen, Bergen, Norway.
| | - Ingrid K Friberg
- Department of International Public Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Zulfiqar A Bhutta
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Hospital for Sick Children, Toronto, Canada; Center of Excellence in Women and Child Health, the Aga Khan University, Karachi, Pakistan
| | - Robert C Pattinson
- South African Medical Research Council, Maternal and Infant Health Care Strategies Unit, Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa
| | - Emma R Allanson
- School of Women's and Infants' Health, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, Crawley, Australia; UNDP/UN Population fund/UNICEF/WHO/World Bank Special Programme of Research, WHO, Geneva, Switzerland
| | - Vicki Flenady
- Mater Research Institute, University of Queensland, Brisbane, Australia; International Stillbirth Alliance, Millburn, NJ, USA
| | | | | | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA
| | - Mary V Kinney
- Save the Children, Saving Newborn Lives, Edgemead, South Africa
| | - Susannah Hopkins Leisher
- Mater Research Institute, University of Queensland, Brisbane, Australia; International Stillbirth Alliance, Millburn, NJ, USA
| | - Catherine Pitt
- Department of Global Healthand Development, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Ajay Khera
- Ministry of Health and Family Welfare, Government of India, Delhi, India
| | - Lakhbir Dhaliwal
- Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Neelam Aggarwal
- Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Neena Raina
- Department of Child and Adolescent Health, WHO Regional Office for South-East Asia, Delhi, India
| | - Marleen Temmerman
- Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, WHO, Geneva, Switzerland
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72
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Ellis A, Chebsey C, Storey C, Bradley S, Jackson S, Flenady V, Heazell A, Siassakos D. Systematic review to understand and improve care after stillbirth: a review of parents' and healthcare professionals' experiences. BMC Pregnancy Childbirth 2016; 16:16. [PMID: 26810220 PMCID: PMC4727309 DOI: 10.1186/s12884-016-0806-2] [Citation(s) in RCA: 160] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 01/18/2016] [Indexed: 11/16/2022] Open
Abstract
Background 2.7 million babies were stillborn in 2015 worldwide; behind these statistics lie the experiences of bereaved parents. The first Lancet series on stillbirth in 2011 described stillbirth as one of the “most shamefully neglected” areas of public health, recommended improving interaction between families and frontline caregivers and made a plea for increased investment in relevant research. Methods A systematic review of qualitative, quantitative and mixed-method studies researching parents and healthcare professionals experiences of care after stillbirth in high-income westernised countries (Europe, North America, Australia and South Africa) was conducted. The review was designed to inform research, training and improve care for parents who experience stillbirth. Results Four thousand four hundred eighty eight abstracts were identified; 52 studies were eligible for inclusion. Synthesis and quantitative aggregation (meta-summary) was used to extract findings and calculate frequency effect sizes (FES%) for each theme (shown in italics), a measure of the prevalence of that finding in the included studies. Researchers’ areas of interest may influence reporting of findings in the literature and result in higher FES sizes, such as; support memory making (53 %) and fathers have different needs (18 %). Other parental findings were more unexpected; Parents want increased public awareness (20 %) and for stillbirth care to be prioritised (5 %). Parental findings highlighted lessons for staff; prepare parents for vaginal birth (23 %), discuss concerns (13 %), give options & time (20 %), privacy not abandonment (30 %), tailored post-mortem discussions (20 %) and post-natal information (30 %). Parental and staff findings were often related; behaviours and actions of staff have a memorable impact on parents (53 %) whilst staff described emotional, knowledge and system-based barriers to providing effective care (100 %). Parents reported distress being caused by midwives hiding behind ‘doing’ and ritualising guidelines whilst staff described distancing themselves from parents and focusing on tasks as coping strategies. Parents and staff both identified the need for improved training (parents 25 % & staff 57 %); continuity of care (parents 15 % & staff 36 %); supportive systems & structures (parents 50 %); and clear care pathways (parents 5 %). Conclusions Parents’ and healthcare workers’ experiences of stillbirth can inform training, improve the provision of care and highlight areas for future research. Electronic supplementary material The online version of this article (doi:10.1186/s12884-016-0806-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alison Ellis
- Obstetrics and Gynaecology, Southmead Hospital, Westbury on Trym, Bristol, BS10 5NB, UK.
| | - Caroline Chebsey
- Obstetrics and Gynaecology, Southmead Hospital, Westbury on Trym, Bristol, BS10 5NB, UK
| | | | | | | | - Vicki Flenady
- Mater Research Institute -The University of Queensland (MRI-UQ), Brisbane, Australia
| | - Alexander Heazell
- Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK.,St. Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, M13 9WL, UK
| | - Dimitrios Siassakos
- Obstetrics and Gynaecology, Southmead Hospital, Westbury on Trym, Bristol, BS10 5NB, UK.,University of Bristol, School of Social & Community Medicine, Bristol, UK
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73
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Goldenberg RL, Saleem S, Pasha O, Harrison MS, Mcclure EM. Reducing stillbirths in low-income countries. Acta Obstet Gynecol Scand 2015; 95:135-43. [PMID: 26577070 DOI: 10.1111/aogs.12817] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 10/20/2015] [Indexed: 11/30/2022]
Abstract
Worldwide, 98% of stillbirths occur in low-income countries (LIC), where stillbirth rates are ten-fold higher than in high-income countries (HIC). Although most HIC stillbirths occur prenatally, in LIC most stillbirths occur at term and during labor/delivery. Conditions causing stillbirths include those of maternal origin (obstructed labor, trauma, antepartum hemorrhage, preeclampsia/eclampsia, infection, diabetes, other maternal diseases), and fetal origin (fetal growth restriction, fetal distress, cord prolapse, multiples, malpresentations, congenital anomalies). In LIC, aside from infectious origins, most stillbirths are caused by fetal asphyxia. Stillbirth prevention requires recognition of maternal conditions, and care in a facility where fetal monitoring and expeditious delivery are possible, usually by cesarean section (CS). Of major causes, only syphilis and malaria can be managed prenatally. Targeting single conditions or interventions is unlikely to substantially reduce stillbirth. To reduce stillbirth rates, LIC must implement effective modern antepartum and intrapartum care, including fetal monitoring and CS.
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Affiliation(s)
- Robert L Goldenberg
- Department Obstetrics and Gynecology, Columbia University, New York, NY, USA
| | - Sarah Saleem
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Omrana Pasha
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Margo S Harrison
- Department Obstetrics and Gynecology, Columbia University, New York, NY, USA
| | - Elizabeth M Mcclure
- Social Statistical and Environmental Health Sciences, Research Triangle Institute, Durham, NC, USA
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74
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Nybo Andersen AM, Gundlund A, Villadsen SF. Stillbirth and congenital anomalies in migrants in Europe. Best Pract Res Clin Obstet Gynaecol 2015; 32:50-9. [PMID: 26545588 DOI: 10.1016/j.bpobgyn.2015.09.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Revised: 09/16/2015] [Accepted: 09/22/2015] [Indexed: 01/07/2023]
Abstract
The risk of giving birth to a stillborn child or a child with severe congenital anomaly is higher for women who have immigrated to Europe as compared to the majority population in the receiving country. The literature, however, reveals great differences between migrant groups, even within migrants from low-income countries, although there is no clear pattern regarding refugee or non-refugee status. This heterogeneity argues against a particular migration-related explanation. There are social disparities in stillbirth risk worldwide, and it has been suggested that the demonstrated ethnic disparity is a result of the socioeconomic disadvantage most migrants face. Consanguinity has been considered as another cause for the increased stillbirth risk and the high risk of congenital anomaly observed in many migrant groups. Utilization and quality of care during pregnancy and childbirth is the third major aspect. All three factors seem to contribute to stillbirth risk, and they should be considered in clinical practice and public health.
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Affiliation(s)
| | - Anna Gundlund
- Department of Public Health, University of Copenhagen, Denmark
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75
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Jakobsson M, Tapper AM, Palomäki O, Ojala K, Pallasmaa N, Ordén MR, Gissler M. Neonatal outcomes after the obstetric near-miss events uterine rupture, abnormally invasive placenta and emergency peripartum hysterectomy - prospective data from the 2009-2011 Finnish NOSS study. Acta Obstet Gynecol Scand 2015; 94:1387-94. [PMID: 26399783 DOI: 10.1111/aogs.12780] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 08/31/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Neonatal outcomes after the maternal obstetric near-miss complications of uterine rupture, abnormally invasive placenta, and emergency peripartum hysterectomy were assessed. MATERIAL AND METHODS This case-control study was conducted as part of the Nordic Obstetric Surveillance Study (NOSS). Data on 211 newborns from 197 deliveries in which an obstetric near-miss complication was involved, were collected prospectively from April 2009 to August 2011 from all Finnish delivery units via questionnaires. Missing cases were obtained from national health registers and confirmed by the clinics. Control populations consisted of all other children born during the same period of time in the Finnish Medical Birth Register (n = 147 551). RESULTS The number of stillbirths in this cohort was high [n = 8, 3.8% vs. 0.3% among controls, odds ratio (OR) 12.5, 95% confidence interval (CI) 6.32-24.9]. In addition, there were two neonatal deaths. The majority of cases (n = 8, 80%) were connected to uterine rupture. The risk of severe birth asphyxia diagnosis was increased compared with controls (n = 17, 8.1% vs. 0.1%, OR 137, 95% CI 82.7-226). A low umbilical artery pH (<7.05) was also observed among these neonates (28.8% vs. 1.0%, OR 28.7, 95% CI 21.5-38.2). Post-term pregnancies were relatively common among the uterine rupture cases. Adverse neonatal outcomes in the AIP and emergency peripartum hysterectomy cases were associated with preterm deliveries. CONCLUSIONS The prospective data collected from clinicians, combined with the information gathered from national health registers, provided valuable insights into rare maternal near-miss cases. These complications also predisposed stillbirth and neonatal death. In this study, 75% of fetal losses were associated with uterine rupture.
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Affiliation(s)
- Maija Jakobsson
- Department of Obstetrics and Gynecology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Anna-Maija Tapper
- Administration, Hyvinkää Hospital, University of Helsinki, Helsinki, Finland
| | - Outi Palomäki
- Department of Obstetrics and Gynecology, Tampere University Hospital, University of Tampere, Tampere, Finland
| | - Kati Ojala
- Department of Obstetrics and Gynecology, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Nanneli Pallasmaa
- Department of Obstetrics and Gynecology, Turku University Hospital, University of Turku, Turku
| | - Maija-Riitta Ordén
- Department of Obstetrics and Gynecology, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland
| | - Mika Gissler
- THL National Institute for Health and Welfare, Helsinki, Finland.,Nordic School of Public Health, Gothenburg, Sweden
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76
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Cheer K. Asia-Pacific women's experiences of stillbirth: A metasynthesis of qualitative literature. Health Care Women Int 2015; 37:889-905. [DOI: 10.1080/07399332.2015.1080261] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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77
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Warland J, O'Brien LM, Heazell AEP, Mitchell EA. An international internet survey of the experiences of 1,714 mothers with a late stillbirth: the STARS cohort study. BMC Pregnancy Childbirth 2015; 15:172. [PMID: 26276347 PMCID: PMC4537542 DOI: 10.1186/s12884-015-0602-4] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 07/28/2015] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Stillbirth occurring after 28 weeks gestation affects between 1.5-4.5 per 1,000 births in high-income countries. The majority of stillbirths in this setting occur in women without risk factors. In addition, many established risk factors such as nulliparity and maternal age are not amenable to modification during pregnancy. Identification of other risk factors which could be amenable to change in pregnancy should be a priority in stillbirth prevention research. Therefore, this study aimed to utilise an online survey asking women who had a stillbirth about their pregnancy in order to identify any common symptoms and experiences. METHODS A web-based survey. RESULTS A total of 1,714 women who had experienced a stillbirth >3 weeks prior to enrolment completed the survey. Common experiences identified were: perception of changes in fetal movement (63% of respondents), reports of a "gut instinct" that something was wrong (68%), and perceived time of death occurring overnight (56%). A quarter of participants believed that their baby's death was due to a cord issue and another 18% indicated that they did not know the reason why their baby died. In many cases (55%) the mother believed the cause of death was different to that told by clinicians. CONCLUSIONS This study confirms the association between altered fetal movements and stillbirth and highlights novel associations that merit closer scrutiny including a maternal gut instinct that something was wrong. The potential importance of maternal sleep is highlighted by the finding of more than half the mothers believing their baby died during the night. This study supports the importance of listening to mothers' concerns and symptoms during pregnancy and highlights the need for thorough investigation of stillbirth and appropriate explanation being given to parents.
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Affiliation(s)
- Jane Warland
- Mothers, Babies and Families: Health Research Group, School of Nursing and Midwifery University of South Australia, Adelaide, SA, Australia.
| | - Louise M O'Brien
- Sleep Disorders Center, Department of Neurology, Department of Obstetrics and Gynecology, and Department of Oral and Maxillofacial Surgery, University of Michigan, Ann Arbor, MI, USA.
| | - Alexander E P Heazell
- Maternal and Fetal Health Research Centre, University of Manchester, Manchester, UK.
| | - Edwin A Mitchell
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand.
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Adekanbi AOA, Olayemi OO, Fawole AO, Afolabi KA. Scourge of intra-partum foetal death in Sub-Saharan Africa. World J Clin Cases 2015; 3:635-9. [PMID: 26244155 PMCID: PMC4517338 DOI: 10.12998/wjcc.v3.i7.635] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 03/09/2015] [Accepted: 04/10/2015] [Indexed: 02/05/2023] Open
Abstract
Intra-partum foetal death has been variously defined. However, a definition adopted at a technical consultation in 2006 is employed in this review. The quality of intra-partum care is a crucial factor for pregnancy outcome for both mothers and new-borns. Intra-partum stillbirth is defined as late foetal death during labour, which clinically presents as fresh stillbirth. The largest proportion of the world's stillbirths occurs in the late preterm, term and intra-partum periods. The Western Pacific region has the greatest reduction in stillbirth with a 3.8% annual decline between 1995 and 2009; however, the annual decline in the African region is less than 1%. Caesarean delivery is still uncommon, especially in rural areas: 1% of births in rural Sub-Saharan Africa and 5% in rural South Asia are by caesarean delivery; 62% of stillbirths occurred during the intra-partum period; 61.4% of stillbirths are attributable to obstetrical complications. Preventive measures aimed at reducing the incidence of intra-partum foetal death entail all measures aimed at improving quality antenatal care and preventing intra-partum asphyxia. This review discusses intra-partum foetal deaths from a Sub-Saharan African perspective. It explores the contribution of research within the region to identifying its impact on new-born health and potential cost-effective policy interventions.
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79
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Nishihara K, Ohki N, Kamata H, Ryo E, Horiuchi S. Automated Software Analysis of Fetal Movement Recorded during a Pregnant Woman's Sleep at Home. PLoS One 2015; 10:e0130503. [PMID: 26083422 PMCID: PMC4470661 DOI: 10.1371/journal.pone.0130503] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 05/20/2015] [Indexed: 11/19/2022] Open
Abstract
Fetal movement is an important biological index of fetal well-being. Since 2008, we have been developing an original capacitive acceleration sensor and device that a pregnant woman can easily use to record fetal movement by herself at home during sleep. In this study, we report a newly developed automated software system for analyzing recorded fetal movement. This study will introduce the system and compare its results to those of a manual analysis of the same fetal movement signals (Experiment I). We will also demonstrate an appropriate way to use the system (Experiment II). In Experiment I, fetal movement data reported previously for six pregnant women at 28-38 gestational weeks were used. We evaluated the agreement of the manual and automated analyses for the same 10-sec epochs using prevalence-adjusted bias-adjusted kappa (PABAK) including quantitative indicators for prevalence and bias. The mean PABAK value was 0.83, which can be considered almost perfect. In Experiment II, twelve pregnant women at 24-36 gestational weeks recorded fetal movement at night once every four weeks. Overall, mean fetal movement counts per hour during maternal sleep significantly decreased along with gestational weeks, though individual differences in fetal development were noted. This newly developed automated analysis system can provide important data throughout late pregnancy.
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Affiliation(s)
- Kyoko Nishihara
- Fatigue and Working Life Research Group, The Institute for Science of Labour, Kanagawa-ken, Japan
- Integrated Brain Function Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | | | - Hideo Kamata
- Department of Obstetrics and Gynecology, Teikyo University, School of Medicine, Tokyo, Japan
| | - Eiji Ryo
- Department of Obstetrics and Gynecology, Teikyo University, School of Medicine, Tokyo, Japan
| | - Shigeko Horiuchi
- Department of Maternal Infant Nursing & Midwifery, St. Luke’s International University, Tokyo, Japan
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80
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Garces A, Mcclure EM, Hambidge K, Krebs NF, Figueroa L, Aguilar M, Moore JL, Goldenberg RL. Trends in perinatal deaths from 2010 to 2013 in the Guatemalan Western Highlands. Reprod Health 2015; 12 Suppl 2:S14. [PMID: 26062407 PMCID: PMC4464607 DOI: 10.1186/1742-4755-12-s2-s14] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background While progress has been made in reducing neonatal mortality in Guatemala, stillbirth and maternal mortality rates remain high, especially among the indigenous populations, which have among the highest adverse pregnancy-related mortality rates in Guatemala. Methods We conducted a prospective study in the Western Highlands of Guatemala from 2010 through 2013, enrolling women during pregnancy with follow-up through 42-days postpartum. All pregnant women were identified and enrolled by study staff in the clusters in the Chimaltenango region for which we had 4 years of data. Enrolment usually occurred during the antenatal period; women were also visited following delivery and 42-days postpartum to collect outcomes. Measures of antenatal and delivery care were also obtained. Results Approximately four thousand women were enrolled annually (3,869 in 2010 to 4,570 in 2013). The stillbirth rate decreased significantly, from 22.0 per 1000 births (95% CI 16.6, 29.0) in 2010 to 16.7 (95% CI 13.5, 20.6) in 2013 (p-value 0.0223). The perinatal mortality rate decreased from 43.9 per 1,000 births (95% CI 36.0, 53.6) to 31.6 (95% CI 27.2, 36.7) (p-value 0.0003). The 28-day neonatal mortality rate decreased from 28.9 per 1000 live births (95% CI 25.2, 33.2) to 21.7 (95% CI 17.5, 26.9), p-value 0.0004. The maternal mortality rate was 134 per 100,000 in 2010 vs. 113 per 100,000 in 2013. Over the same period, hospital birth rates increased from 30.0 to 50.3%. Conclusions In a relatively short time period, significant improvements in neonatal, fetal and perinatal mortality were noted in an area of Guatemala with a history of poor pregnancy outcomes. These changes were temporally related to major increases in hospital-based delivery with skilled birth attendants, as well as improvements in the quality of delivery care, neonatal care, and prenatal care.
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Bucher S, Marete I, Tenge C, Liechty EA, Esamai F, Patel A, Goudar SS, Kodkany B, Garces A, Chomba E, Althabe F, Barreuta M, Pasha O, Hibberd P, Derman RJ, Otieno K, Hambidge K, Krebs NF, Carlo WA, Chemweno C, Goldenberg RL, McClure EM, Moore JL, Wallace DD, Saleem S, Koso-Thomas M. A prospective observational description of frequency and timing of antenatal care attendance and coverage of selected interventions from sites in Argentina, Guatemala, India, Kenya, Pakistan and Zambia. Reprod Health 2015; 12 Suppl 2:S12. [PMID: 26063483 PMCID: PMC4464209 DOI: 10.1186/1742-4755-12-s2-s12] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background The Global Network for Women’s and Children’s Health Research is one of the largest international networks for testing and generating evidence-based recommendations for improvement of maternal-child health in resource-limited settings. Since 2009, Global Network sites in six low and middle-income countries have collected information on antenatal care practices, which are important as indicators of care and have implications for programs to improve maternal and child health. We sought to: (1) describe the quantity of antenatal care attendance over a four-year period; and (2) explore the quality of coverage for selected preventative, screening, and birth preparedness components. Methods The Maternal Newborn Health Registry (MNHR) is a prospective, population-based birth and pregnancy outcomes registry in Global Network sites, including: Argentina, Guatemala, India (Belgaum and Nagpur), Kenya, Pakistan, and Zambia. MNHR data from these sites were prospectively collected from January 1, 2010 – December 31, 2013 and analyzed for indicators related to quantity and patterns of ANC and coverage of key elements of recommended focused antenatal care. Descriptive statistics were generated overall by global region (Africa, Asia, and Latin America), and for each individual site. Results Overall, 96% of women reported at least one antenatal care visit. Indian sites demonstrated the highest percentage of women who initiated antenatal care during the first trimester. Women from the Latin American and Indian sites reported the highest number of at least 4 visits. Overall, 88% of women received tetanus toxoid. Only about half of all women reported having been screened for syphilis (49%) or anemia (50%). Rates of HIV testing were above 95% in the Argentina, African, and Indian sites. The Pakistan site demonstrated relatively high rates for birth preparation, but for most other preventative and screening interventions, posted lower coverage rates as compared to other Global Network sites. Conclusions Results from our large, prospective, population-based observational study contribute important insight into regional and site-specific patterns for antenatal care access and coverage. Our findings indicate a quality and coverage gap in antenatal care services, particularly in regards to syphilis and hemoglobin screening. We have identified site-specific gaps in access to, and delivery of, antenatal care services that can be targeted for improvement in future research and implementation efforts. Trial registration Registration at Clinicaltrials.gov (ID# NCT01073475)
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82
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Munabi IG, Luboga SA, Mirembe F. A cross sectional study evaluating screening using maternal anthropometric measurements for outcomes of childbirth in Ugandan mothers at term. BMC Res Notes 2015; 8:205. [PMID: 26032185 PMCID: PMC4467626 DOI: 10.1186/s13104-015-1183-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 05/20/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Birth related newborn and maternal mortality/morbidity remains high in most of sub-Saharan Africa compared to the rest of the world. In this low income region there is a need for valid, low cost, easy to use mass screening tests. This study looked at the screening value of maternal: height, weight and pelvis height, for assessing the outcomes of parturition in Ugandan mothers at term. METHODS This was a multi site cross-sectional study on mothers with singleton pregnancies in labour at various hospitals in different parts of Uganda. A summary of the details of the pregnancy, maternal height, weight and the delivery record were captured and analysed to generate descriptive and inferential (multilevel logistic regression analysis) and diagnostic (Receiver Operator Curve analysis) statistics. RESULTS We recruited 1146 mothers from all the study sites during the study period of whom 987 (86.13%) had normal deliveries and healthy babies. Mothers with adverse outcomes included 107 mothers that had caesarean section and 52 mothers who had vaginal deliveries with foetal Apgar score of ≤7 at 5 min of whom 11 had fresh still births. Maternal height (Adj OR 0.97, 95% CI 0.94-1.00) and maternal pelvis height (Adj OR 0.73, 95% CI 0.61-0.86) were significantly associated with adverse pregnancy outcomes. The combination of maternal: height (<150 cm), weight (>55.7 kg) and pelvis height (>8.95 cm) had the best diagnostic value with a combined area under the curve of 0.60. CONCLUSIONS It was observed that an increase in either maternal pelvis height or maternal height was associated with a significant reduction in adverse pregnancy outcomes. The cut off values of all three evaluated maternal anthropometric measurements were of low test accuracy as screening tests even when used together. Further research is needed to develop low cost screening tools for use in low income settings.
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Affiliation(s)
- Ian G Munabi
- Department of Human Anatomy, School of Biomedical Sciences, Makerere University College of Health Sciences, New Mulago Hospital Complex, P. O. Box 7072, Kampala, Uganda.
| | - Samuel Abilemech Luboga
- Department of Human Anatomy, School of Biomedical Sciences, Makerere University College of Health Sciences, New Mulago Hospital Complex, P. O. Box 7072, Kampala, Uganda.
| | - Florence Mirembe
- Department of Obstetrics and Gynaecology, School of Medicine, Makerere University College of Health Sciences, New Mulago Hospital Complex, Kampala, Uganda.
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von Dadelszen P, Magee LA, Payne BA, Dunsmuir DT, Drebit S, Dumont GA, Miller S, Norman J, Pyne-Mercier L, Shennan AH, Donnay F, Bhutta ZA, Ansermino JM. Moving beyond silos: How do we provide distributed personalized medicine to pregnant women everywhere at scale? Insights from PRE-EMPT. Int J Gynaecol Obstet 2015; 131 Suppl 1:S10-5. [PMID: 26433496 DOI: 10.1016/j.ijgo.2015.02.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
While we believe that pre-eclampsia matters-because it remains a leading cause of maternal and perinatal morbidity and mortality worldwide-we are convinced that the time has come to look beyond single clinical entities (e.g. pre-eclampsia, postpartum hemorrhage, obstetric sepsis) and to look for an integrated approach that will provide evidence-based personalized care to women wherever they encounter the health system. Accurate outcome prediction models are a powerful way to identify individuals at incrementally increased (and decreased) risks associated with a given condition. Integrating models with decision algorithms into mobile health (mHealth) applications could support community and first level facility healthcare providers to identify those women, fetuses, and newborns most at need of facility-based care, and to initiate lifesaving interventions in their communities prior to transportation. In our opinion, this offers the greatest opportunity to provide distributed individualized care at scale, and soon.
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Affiliation(s)
- Peter von Dadelszen
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada; Child and Family Research Institute, University of British Columbia, Vancouver, BC, Canada.
| | - Laura A Magee
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada; Child and Family Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Beth A Payne
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada; Child and Family Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Dustin T Dunsmuir
- Department of Anesthesia, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada; Child and Family Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Sharla Drebit
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada; Child and Family Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Guy A Dumont
- Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, BC, Canada; Child and Family Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Suellen Miller
- Department of Obstetrics, Gynecology and Reproductive Sciences and Bixby Center for Global Reproductive Health, University of California, San Francisco, CA, USA
| | - Jane Norman
- University of Edinburgh/MRC Centre for Reproductive Health, The Queen's Medical Research Institute, University of Edinburgh, UK
| | - Lee Pyne-Mercier
- Family Health Team, Bill & Melinda Gates Foundation, USA; Department of Global Health, University of Washington, Seattle, WA, USA
| | | | - France Donnay
- Family Health Team, Bill & Melinda Gates Foundation, USA
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, University of Toronto, Toronto, Canada; Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - J Mark Ansermino
- Department of Anesthesia, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada; Child and Family Research Institute, University of British Columbia, Vancouver, BC, Canada
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Goldenberg RL, McClure EM. Maternal, fetal and neonatal mortality: lessons learned from historical changes in high income countries and their potential application to low-income countries. Matern Health Neonatol Perinatol 2015; 1:3. [PMID: 27057321 PMCID: PMC4772754 DOI: 10.1186/s40748-014-0004-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 11/07/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND There are large differences in pregnancy outcome between high income countries and many middle and low income countries. In fact, maternal, fetal and neonatal mortality rates in many low-income countries approximate those that were seen in high-income countries nearly a century ago. FINDINGS This paper documents the very substantial reductions in maternal, fetal and neonatal mortality rates in high income countries over the last century and explores the likely reasons for those reductions. The conditions responsible for the current high mortality rates in low and middle income countries are discussed as are the interventions likely to result in substantial reductions in maternal, fetal and neonatal mortality from those conditions. The conditions that result in maternal mortality are often responsible for fetal and neonatal mortality and the interventions that save maternal lives often reduce fetal and neonatal mortality as well. Single interventions rarely achieve substantial reductions in mortality. Instead, upgrading the system of care so that appropriate interventions could be applied at appropriate times is most likely to achieve the desired reductions in maternal, fetal and neonatal mortality.
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Affiliation(s)
- Robert L Goldenberg
- />Department of Obstetrics and Gynecology, Columbia University Medicine Center, New York, NY USA
| | - Elizabeth M McClure
- />Social, Statistical and Environmental Health Sciences, RTI International, Durham, NC USA
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85
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Meaney S, Gallagher S, Lutomski JE, O'Donoghue K. Parental decision making around perinatal autopsy: a qualitative investigation. Health Expect 2014; 18:3160-71. [PMID: 25376775 DOI: 10.1111/hex.12305] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2014] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Decades of decline in uptake rates of perinatal autopsies has limited investigation into the causes and risk factors for stillbirth. AIMS This study aimed to qualitatively explore perinatal autopsy decision-making processes in parents who experienced antepartum and intrapartum stillbirths. MATERIAL AND METHODS A qualitative semi-structured interview format was utilized. The line of questioning centred on how parents came to decide on consenting or declining to have a perinatal autopsy undertaken. Interpretative phenomenological analysis was employed as the analytic strategy. Purposive sampling was used to recruit 10 parents who either consented or declined autopsy from a large tertiary maternity hospital in Cork Ireland, where there were 30 stillbirths in 2011. RESULTS Findings revealed four superordinate themes influencing parents' decision-making which varied with type of stillbirth experienced. Those parents who experienced antepartum stillbirths were more likely to consent; thus, knowing that the child was stillborn prior to delivery rather than on the day of delivery was associated with consent. In fact, these parents had more time for meaning-making; those consenting wanted to rule out self-blame and were fearful about future pregnancies. Parents who declined autopsy wanted to protect their infant from further harm. Interestingly, parents' knowledge and understanding of the autopsy itself were acquired primarily from public discourse. CONCLUSION Parents' decision-making regarding autopsy is profoundly affected by their emotional response to stillbirth; clinicians and other health professionals may play a key role, especially if they can address parental concerns regarding the invasiveness of the autopsy procedure.
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Affiliation(s)
- Sarah Meaney
- National Perinatal Epidemiology Centre, University College Cork, Cork, Ireland
| | - Stephen Gallagher
- Centre for Social Issues Research, Department of Psychology, University of Limerick, Limerick, Ireland
| | - Jennifer E Lutomski
- National Perinatal Epidemiology Centre, University College Cork, Cork, Ireland.,Nijmegen Centre for Evidence Based Practice, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Keelin O'Donoghue
- Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
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Woolner AMF, Bhattacharya S. Obesity and stillbirth. Best Pract Res Clin Obstet Gynaecol 2014; 29:415-26. [PMID: 25457855 DOI: 10.1016/j.bpobgyn.2014.07.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 07/24/2014] [Indexed: 01/28/2023]
Abstract
Recent years have witnessed a rise in maternal obesity, which is independently associated with an increased risk of stillbirth. The pathophysiology is unclear, but it is likely related to abnormal placental function, and inflammatory, metabolic and hormonal imbalances in the mother. Obesity is associated with conditions such as diabetes, which can also cause stillbirth. In order to reduce the risk of obesity-associated stillbirth, women of reproductive age should be actively encouraged to optimise their pre-pregnancy weight as the safety of weight loss interventions during pregnancy is unproven. Obese and extremely obese women should be treated as high-risk obstetric patients, with increased antenatal surveillance and specialist input. The postnatal period may be a useful time to provide weight management advice to women to prevent interpregnancy weight gain and reduce the risk of stillbirth in subsequent pregnancies.
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Affiliation(s)
- Andrea M F Woolner
- Obstetrics & Gynaecology, Division of Applied Health Sciences, School of Medicine and Dentistry, University of Aberdeen, Aberdeen Maternity Hospital, Cornhill Road, Aberdeen AB25 2ZL, UK.
| | - Siladitya Bhattacharya
- Head of Division of Applied Health Sciences, School of Medicine and Dentistry, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK.
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Ntambue A, Malonga F, Dramaix-Wilmet M, Donnen P. [Perinatal mortality: extent and causes in Lubumbashi, Democratic Republic of Congo]. Rev Epidemiol Sante Publique 2014; 61:519-29. [PMID: 24409524 DOI: 10.1016/j.respe.2013.07.684] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The present study was initiated in order to determine the rate, the causes and the risk factors for perinatal mortality in Lubumbashi, Democratic Republic of Congo. METHODS Data for this cross-sectional study were collected by interviewing participating women and by analysis of medical files. Women who gave birth in 2010 and were residents of Lubumbashi during the same year were included.Women were included irrespective of the pregnancy outcome and perinatal survival was determined for newborns aged at least seven days.Women were recruited from households selected by cluster sampling for healthcare zones. Perinatal mortality was defined as stillbirths and early neonatal deaths per 1000 births. Risk factors were sought using the odds ratio method adjusted by logistic regression using a 5% threshold. RESULTS Among 11,536 surveyed women, there were 11,633 births including 177 stillbirths and 133 early neonatal deaths. Perinatal mortality was 27% (95%IC = 23.7–29.6%). The causes of this mortality were respiratory distress (58.2%), neonatal infection (pneumonia and neonatal meningitis, 13.5%), complications of prematurity (9.0%), neonatal tetanus (1.6%), congenital malformations (0.6%). The cause of perinatal death was unknown for 17.1%. Risk factors for perinatal mortality were: unmarried mother; home delivery; complicated delivery; dystocia; caesareansection; multiple pregnancy; low birth weight; prematurity. CONCLUSION Action should be taken to improve availability, use and quality of Emergency obstetrical and neonatal care. Women should be better informed concerning the danger signs of pregnancy and childbirth.
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Ibiebele I, Coory M, Boyle FM, Humphrey M, Vlack S, Flenady V. Stillbirth rates among Indigenous and non-Indigenous women in Queensland, Australia: is the gap closing? BJOG 2014; 122:1476-83. [DOI: 10.1111/1471-0528.13047] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2014] [Indexed: 11/30/2022]
Affiliation(s)
- I Ibiebele
- Translating Research Into Practice (TRIP) Centre; Mater Research Institute-University of Queensland; Brisbane Qld Australia
- School of Population Health; University of Queensland; Brisbane Qld Australia
| | - M Coory
- Murdoch Childrens Research Institute; Melbourne Vic. Australia
- Department of Paediatrics; University of Melbourne; Melbourne Vic. Australia
| | - FM Boyle
- School of Population Health; University of Queensland; Brisbane Qld Australia
- Australia and New Zealand Stillbirth Alliance; Brisbane Qld Australia
| | - M Humphrey
- Queensland Maternal and Perinatal Quality Council; Brisbane Qld Australia
| | - S Vlack
- School of Population Health; University of Queensland; Brisbane Qld Australia
- Queensland Health Metro North Brisbane Public Health Unit; Brisbane Qld Australia
| | - V Flenady
- Translating Research Into Practice (TRIP) Centre; Mater Research Institute-University of Queensland; Brisbane Qld Australia
- Australia and New Zealand Stillbirth Alliance; Brisbane Qld Australia
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King ML, Aden A, Tapa S, Jumah R, Khan S. Evidence-based stillbirth prevention strategies: combining empirical and theoretical paradigms to inform health planning and decision-making. Worldviews Evid Based Nurs 2014; 11:258-65. [PMID: 25040460 DOI: 10.1111/wvn.12048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2014] [Indexed: 11/28/2022]
Abstract
INTRODUCTION A global health project undertaken in Qatar on the Arabian Peninsula immersed undergraduate nursing students in hands-on learning to address the question: What strategies are effective in preventing stillbirth? Worldwide stillbirth estimates of 2.6 million per year and the high rate in the Eastern Mediterranean Region of 27 per 1,000 total live births provided the stimulus for this inquiry. METHODS We used a dual empirical and theoretical approach that combined the principles of evidence-based practice and population health planning. Students were assisted to translate pre-appraised literature based on the 6S hierarchical pyramid of evidence. The PRECEDE-PROCEED (P-P) model served as an organizing template to assemble data extracted from the appraisal of 21 systematic literature reviews ± meta-analyses, 2 synopses of synthesized reports, and 9 individual studies summarizing stillbirth prevention strategies in low, middle, and high income countries. Consistent with elements of the P-P model, stillbirth prevention strategies were classified as social, epidemiological, educational, ecological, administrative, or policy. RESULTS Ten recommendations with clear evidence of effectiveness in preventing stillbirth in low, middle, or high income countries were identified. Several other promising interventions were identified with weak, uncertain, or inconclusive evidence. These require further rigorous testing. LINKING EVIDENCE TO ACTION Two complementary paradigms--evidence-based practice and an ecological population health program planning model--helped baccalaureate nursing students transfer research evidence into useable knowledge for practice. They learned the importance of comprehensive assessments and evidence-informed interventions. The multidimensional elements of the P-P model sensitized students to the complex interrelated factors influencing stillbirth and its prevention.
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Affiliation(s)
- Mary Lou King
- Assistant Professor, University of Calgary-Qatar, Doha, Qatar
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Abstract
Nearly a decade ago, The Lancet published the Neonatal Survival Series, with an ambitious call for integration of newborn care across the continuum of reproductive, maternal, newborn, and child health and nutrition (RMNCH). In this first of five papers in the Every Newborn Series, we consider what has changed during this decade, assessing progress on the basis of a systematic policy heuristic including agenda-setting, policy formulation and adoption, leadership and partnership, implementation, and evaluation of effect. Substantial progress has been made in agenda setting and policy formulation for newborn health, as witnessed by the shift from maternal and child health to maternal, newborn, and child health as a standard. However, investment and large-scale implementation have been disappointingly small, especially in view of the size of the burden and potential for rapid change and synergies throughout the RMNCH continuum. Moreover, stillbirths remain invisible on the global health agenda. Hence that progress in improvement of newborn survival and reduction of stillbirths lags behind that of maternal mortality and deaths for children aged 1-59 months is not surprising. Faster progress is possible, but with several requirements: clear communication of the interventions with the greatest effect and how to overcome bottlenecks for scale-up; national leadership, and technical capacity to integrate and implement these interventions; global coordination of partners, especially within countries, in provision of technical assistance and increased funding; increased domestic investment in newborn health, and access to specific commodities and equipment where needed; better data to monitor progress, with local data used for programme improvement; and accountability for results at all levels, including demand from communities and mortality targets in the post-2015 framework. Who will step up during the next decade to ensure decision making in countries leads to implementation of stillbirth and newborn health interventions within RMNCH programmes?
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Affiliation(s)
- Gary L Darmstadt
- Global Development Division, Bill & Melinda Gates Foundation, Seattle, WA, USA.
| | - Mary V Kinney
- Saving Newborn Lives/Save the Children, Cape Town, South Africa
| | | | - Simon Cousens
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK; Centre for Maternal Reproductive and Child Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Lily Kak
- United States Agency for International Development, Washington, DC, USA
| | - Vinod K Paul
- All India Institute of Medical Sciences, New Delhi, India
| | - Jose Martines
- Department of Maternal, Newborn, Child and Adolescent Health, WHO, Geneva, Switzerland; Centre for Intervention Science in Maternal and Child Health, Centre for International Health, University of Bergen, Bergen, Norway
| | - Zulfiqar A Bhutta
- Center for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada; Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Joy E Lawn
- Saving Newborn Lives/Save the Children, Cape Town, South Africa; Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK; Centre for Maternal Reproductive and Child Health, London School of Hygiene & Tropical Medicine, London, UK; Research and Evidence Division, Department for International Development, London, UK
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Lawn JE, Blencowe H, Oza S, You D, Lee ACC, Waiswa P, Lalli M, Bhutta Z, Barros AJD, Christian P, Mathers C, Cousens SN. Every Newborn: progress, priorities, and potential beyond survival. Lancet 2014; 384:189-205. [PMID: 24853593 DOI: 10.1016/s0140-6736(14)60496-7] [Citation(s) in RCA: 1156] [Impact Index Per Article: 115.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In this Series paper, we review trends since the 2005 Lancet Series on Neonatal Survival to inform acceleration of progress for newborn health post-2015. On the basis of multicountry analyses and multi-stakeholder consultations, we propose national targets for 2035 of no more than 10 stillbirths per 1000 total births, and no more than 10 neonatal deaths per 1000 livebirths, compatible with the under-5 mortality targets of no more than 20 per 1000 livebirths. We also give targets for 2030. Reduction of neonatal mortality has been slower than that for maternal and child (1-59 months) mortality, slowest in the highest burden countries, especially in Africa, and reduction is even slower for stillbirth rates. Birth is the time of highest risk, when more than 40% of maternal deaths (total about 290,000) and stillbirths or neonatal deaths (5·5 million) occur every year. These deaths happen rapidly, needing a rapid response by health-care workers. The 2·9 million annual neonatal deaths worldwide are attributable to three main causes: infections (0·6 million), intrapartum conditions (0·7 million), and preterm birth complications (1·0 million). Boys have a higher biological risk of neonatal death, but girls often have a higher social risk. Small size at birth--due to preterm birth or small-for-gestational-age (SGA), or both--is the biggest risk factor for more than 80% of neonatal deaths and increases risk of post-neonatal mortality, growth failure, and adult-onset non-communicable diseases. South Asia has the highest SGA rates and sub-Saharan Africa has the highest preterm birth rates. Babies who are term SGA low birthweight (10·4 million in these regions) are at risk of stunting and adult-onset metabolic conditions. 15 million preterm births, especially of those younger than 32 weeks' gestation, are at the highest risk of neonatal death, with ongoing post-neonatal mortality risk, and important risk of long-term neurodevelopmental impairment, stunting, and non-communicable conditions. 4 million neonates annually have other life-threatening or disabling conditions including intrapartum-related brain injury, severe bacterial infections, or pathological jaundice. Half of the world's newborn babies do not get a birth certificate, and most neonatal deaths and almost all stillbirths have no death certificate. To count deaths is crucial to change them. Failure to improve birth outcomes by 2035 will result in an estimated 116 million deaths, 99 million survivors with disability or lost development potential, and millions of adults at increased risk of non-communicable diseases after low birthweight. In the post-2015 era, improvements in child survival, development, and human capital depend on ensuring a healthy start for every newborn baby--the citizens and workforce of the future.
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Affiliation(s)
- Joy E Lawn
- Centre for Maternal Reproductive & Child Health, and Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Saving Newborn Lives/Save the Children USA, Washington, DC, USA; Research and Evidence Division, Department for International Development, London, UK.
| | - Hannah Blencowe
- Centre for Maternal Reproductive & Child Health, and Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Shefali Oza
- Centre for Maternal Reproductive & Child Health, and Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Danzhen You
- Division of Policy and Strategy, UNICEF, New York, NY, USA
| | - Anne C C Lee
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Peter Waiswa
- Makerere University, School of Public Health, Kampala, Uganda; Division of Global Health, Karolinska Institutet, Stockholm, Sweden
| | - Marek Lalli
- Centre for Maternal Reproductive & Child Health, and Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Zulfiqar Bhutta
- Center for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada; Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Aluisio J D Barros
- Universidade Federal de Pelotas, Pelotas, Brasil; Countdown to 2015 Equity Technical Working Group, Pelotas, Brasil
| | - Parul Christian
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Colin Mathers
- Mortality and Burden of Disease Unit, WHO, Geneva, Switzerland
| | - Simon N Cousens
- Centre for Maternal Reproductive & Child Health, and Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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92
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Saleem S, McClure EM, Goudar SS, Patel A, Esamai F, Garces A, Chomba E, Althabe F, Moore J, Kodkany B, Pasha O, Belizan J, Mayansyan A, Derman RJ, Hibberd PL, Liechty EA, Krebs NF, Hambidge KM, Buekens P, Carlo WA, Wright LL, Koso-Thomas M, Jobe AH, Goldenberg RL. A prospective study of maternal, fetal and neonatal deaths in low- and middle-income countries. Bull World Health Organ 2014; 92:605-12. [PMID: 25177075 DOI: 10.2471/blt.13.127464] [Citation(s) in RCA: 119] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 02/13/2014] [Accepted: 03/10/2014] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To quantify maternal, fetal and neonatal mortality in low- and middle-income countries, to identify when deaths occur and to identify relationships between maternal deaths and stillbirths and neonatal deaths. METHODS A prospective study of pregnancy outcomes was performed in 106 communities at seven sites in Argentina, Guatemala, India, Kenya, Pakistan and Zambia. Pregnant women were enrolled and followed until six weeks postpartum. FINDINGS Between 2010 and 2012, 214,070 of 220,235 enrolled women (97.2%) completed follow-up. The maternal mortality ratio was 168 per 100,000 live births, ranging from 69 per 100,000 in Argentina to 316 per 100,000 in Pakistan. Overall, 29% (98/336) of maternal deaths occurred around the time of delivery: most were attributed to haemorrhage (86/336), pre-eclampsia or eclampsia (55/336) or sepsis (39/336). Around 70% (4349/6213) of stillbirths were probably intrapartum; 34% (1804/5230) of neonates died on the day of delivery and 14% (755/5230) died the day after. Stillbirths were more common in women who died than in those alive six weeks postpartum (risk ratio, RR: 9.48; 95% confidence interval, CI: 7.97-11.27), as were perinatal deaths (RR: 4.30; 95% CI: 3.26-5.67) and 7-day (RR: 3.94; 95% CI: 2.74-5.65) and 28-day neonatal deaths (RR: 7.36; 95% CI: 5.54-9.77). CONCLUSION Most maternal, fetal and neonatal deaths occurred at or around delivery and were attributed to preventable causes. Maternal death increased the risk of perinatal and neonatal death. Improving obstetric and neonatal care around the time of birth offers the greatest chance of reducing mortality.
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Affiliation(s)
- Sarah Saleem
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Elizabeth M McClure
- Social, Statistical and Environmental Sciences, RTI International, PO Box 12194, 3040 East Cornwallis Road, Durham, NC 27709-2194, United States of America (USA)
| | | | | | - Fabian Esamai
- Department of Pediatrics, Moi University, Eldoret, Kenya
| | - Ana Garces
- Universidad Francisco Marroquin, Guatemala City, Guatemala
| | - Elwyn Chomba
- Department of Pediatrics, University of Zambia, Lusaka, Zambia
| | | | - Janet Moore
- Social, Statistical and Environmental Sciences, RTI International, PO Box 12194, 3040 East Cornwallis Road, Durham, NC 27709-2194, United States of America (USA)
| | | | - Omrana Pasha
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Jose Belizan
- Institute of Clinical Effectiveness, Buenos Aires, Argentina
| | | | - Richard J Derman
- Department of Obstetrics and Gynecology, Christiana Health Care, Newark, USA
| | - Patricia L Hibberd
- Department of Pediatrics, Massachusetts General Hospital for Children, Boston, USA
| | - Edward A Liechty
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, USA
| | - Nancy F Krebs
- Department of Pediatrics, University of Colorado Health Sciences Center, Denver, USA
| | - K Michael Hambidge
- Department of Pediatrics, University of Colorado Health Sciences Center, Denver, USA
| | - Pierre Buekens
- Tulane University School of Public Health and Tropical Medicine, New Orleans, USA
| | | | - Linda L Wright
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, USA
| | - Marion Koso-Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, USA
| | - Alan H Jobe
- Department of Pediatrics, Cincinnati Children's Hospital, Cincinnati, USA
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93
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Girard S, Heazell AEP, Derricott H, Allan SM, Sibley CP, Abrahams VM, Jones RL. Circulating cytokines and alarmins associated with placental inflammation in high-risk pregnancies. Am J Reprod Immunol 2014; 72:422-34. [PMID: 24867252 PMCID: PMC4369138 DOI: 10.1111/aji.12274] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 04/29/2014] [Indexed: 12/28/2022] Open
Abstract
Problem Inflammation during pregnancy has devastating consequences for the placenta and fetus. These events are incompletely understood, thereby hampering screening and treatment. Method of study The inflammatory profile of villous tissue was studied in pregnancies at high-risk of placental dysfunction and compared to uncomplicated pregnancies. The systemic inflammatory profile was assessed in matched maternal serum samples in cases of reduced fetal movements (RFM). Results Placentas from RFM pregnancies had a unique inflammatory profile characterized by increased interleukin (IL)-1 receptor antagonist and decreased IL-10 expression, concomitant with increased numbers of placental macrophages. This aberrant cytokine profile was evident in maternal serum in RFM, as were increased levels of alarmins (uric acid, HMGB1, cell-free fetal DNA). Conclusion This distinct inflammatory profile at the maternal-fetal interface, mirrored in maternal serum, could represent biomarkers of placental inflammation and could offer novel therapeutic options to protect the placenta and fetus from an adverse maternal environment.
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Affiliation(s)
- Sylvie Girard
- Maternal and Fetal Health Research Centre, Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK; Manchester Academic Health Science Centre, St. Mary's Hospital, Central Manchester University Hospital NHS Foundation Trust, Manchester, UK; Faculty of Life Sciences, University of Manchester, Manchester, UK
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94
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Qualitative assessment of attitudes and knowledge on preterm birth in Malawi and within country framework of care. BMC Pregnancy Childbirth 2014; 14:123. [PMID: 24690288 PMCID: PMC3975452 DOI: 10.1186/1471-2393-14-123] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Accepted: 03/27/2014] [Indexed: 11/25/2022] Open
Abstract
Background The overarching goal of this study was to qualitatively assess baseline knowledge and perceptions regarding preterm birth (PTB) and oral health in an at-risk, low resource setting surrounding Lilongwe, Malawi. The aims were to determine what is understood regarding normal length of gestation and how gestational age is estimated, to identify common language for preterm birth, and to assess what is understood as options for PTB management. As prior qualitative research had largely focused on patient or client-based focused groups, we primarily focused on groups comprised of community health workers (CHWs) and providers. Methods A qualitative study using focus-group discussions, incidence narrative, and informant interviews amongst voluntary participants. Six focus groups were comprised of CHWs, patient couples, midwives, and clinical officers (n = 33) at two rural health centers referring to Kamuzu Central Hospital. Semi-structured questions facilitated discussion of PTB and oral health (inclusive of periodontal disease), including definitions, perception, causation, management, and accepted interventions. Results Every participant knew of women who had experienced “a baby born too soon”, or preterm birth. All participants recognized both an etiology conceptualization and disease framework for preterm birth, distinguished PTB from miscarriage and macerated stillbirth, and articulated a willingness to engage in studies aimed at prevention or management. Identified gaps included: (1) discordance in the definition of PTB (i.e., 28–34 weeks or less than the 8th month, but with a corresponding fetal weight ranging 500 to 2300 grams); (2) utility and regional availability of antenatal steroids for prevention of preterm infant morbidity and mortality; (3) need for antenatal referral for at-risk women, or with symptoms of preterm birth. There was no evident preference for route of progesterone for the prevention of recurrent PTB. Conclusions Qualitative research was useful in (1) identifying gaps in knowledge in urban and rural Malawi, and (2) informing the development of educational materials and implementation of programs or trials ultimately aimed at reducing PTB. As a result of this qualitative work, implementation planning was focused on the gaps in knowledge, dissemination of knowledge (to both patients and providers), and practical solutions to barriers in known efficacious therapies.
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95
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Gold KJ, Abdul-Mumin ARS, Boggs ME, Opare-Addo HS, Lieberman RW. Assessment of "fresh" versus "macerated" as accurate markers of time since intrauterine fetal demise in low-income countries. Int J Gynaecol Obstet 2014; 125:223-7. [PMID: 24680841 DOI: 10.1016/j.ijgo.2013.12.006] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 12/03/2013] [Accepted: 02/25/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To compare provider assessment of fetal maceration with death-to-delivery interval to evaluate the reliability of appearance as a proxy for time of death. METHODS Cohort chart abstraction was performed for all stillbirth deliveries at or above 28 weeks of gestation during a 1-year period in a teaching hospital in Ghana. RESULTS Of 470 stillborn infants, 337 had adequate data for analysis. Of 47 fetuses alive on admission with death-to-delivery intervals estimated to be less than 8 hours (expected to be reported as fresh), 14 (30%) were actually reported as macerated. Of 94 cases in which the fetus was deceased on admission with death-to-delivery interval of more than 8 hours (expected to be macerated), 17 (18%) were described as fresh. CONCLUSION Provider description of fetal appearance may be an unreliable indicator for time since fetal death. The findings have significant implications for stillbirth prevention and assessment.
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Affiliation(s)
- Katherine J Gold
- Department of Family Medicine, University of Michigan, Ann Arbor, USA; Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, USA.
| | - Abdul-Razak S Abdul-Mumin
- Department of Obstetrics and Gynaecology, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Martha E Boggs
- Department of Family Medicine, University of Michigan, Ann Arbor, USA
| | - Henry S Opare-Addo
- Department of Obstetrics and Gynaecology, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Richard W Lieberman
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, USA; Department of Pathology, University of Michigan, Ann Arbor, USA
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96
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Ali AAA, Elgessim ME, Taha E, Adam GK. Factors associated with perinatal mortality in Kassala, Eastern Sudan: a community-based study 2010-2011. J Trop Pediatr 2014; 60:79-82. [PMID: 24052575 DOI: 10.1093/tropej/fmt075] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This study investigated the factors associated with perinatal mortality in eastern Sudan from 2010 to 2011. Among 808 deliveries, there were 15 pairs of twins, giving 823 babies at risk of perinatal deaths. There were 761 live births and 62 perinatal deaths. Of the 62 perinatal deaths, 25 (40.3%) were stillbirths and 37 (59.7%) were early neonatal deaths. The stillbirth risk, early neonatal mortality risk and perinatal mortality rate were 30.9 per 1000 pregnancies, 48.6 per 1000 live births and 75.3 per 1000 births, respectively. In the logistic regression model, home delivery [odds ratio (OR) = 5.1; confidence interval CI = 1.8-14; p = 0.001] and parity ≥3 (OR = 4.5; CI = 2.2-8.8; p < 0.001) were predictors for perinatal deaths, whereas use of antenatal care (OR = 0.3; CI = 0.1-0.6; p = 0.002), use of a mosquito net (OR = 0.07; CI = 0.03-0.1; p < 0.001) and antenatal iron supplementation for at least 3 months (OR = 0.06; CI = 0.02-0.1; p < 0.001) were significant protective factors of perinatal deaths.
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Affiliation(s)
- Abdel Aziem A Ali
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kassala University, Sudan
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97
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Liu B, Roberts CL, Clarke M, Jorm L, Hunt J, Ward J. Chlamydia and gonorrhoea infections and the risk of adverse obstetric outcomes: a retrospective cohort study. Sex Transm Infect 2013; 89:672-8. [DOI: 10.1136/sextrans-2013-051118] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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98
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Roberts DJ. Perinatal pathology: practice suggestions for limited-resource settings. Arch Pathol Lab Med 2013; 137:775-81. [PMID: 23721272 DOI: 10.5858/arpa.2011-0560-sa] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The practice of perinatal pathology in much of the world suffers, as do all subspecialties of anatomic pathology, from inadequate resources (equipment, consumables, and both professional and technical personnel), from lack of education (not only of the pathologist but also of the clinicians responsible for sending the specimens, and the technicians processing the specimens), and from lack of appropriate government sector support. Perinatal pathology has significant public health-related utility and should be championing its service by providing maternal and fetal/infant mortality and morbidity data to governmental health ministries. It is with this pathologic data that informed decisions can be made on health-related courses of action and allocation of resources. These perinatal pathology data are needed to develop appropriate public health initiatives, specifically toward achieving the Millennium Developmental Goals as the best way to effectively decrease infant and maternal deaths and to determine causes of perinatal mortality and morbidity. The following overview will focus on the utility of perinatal pathology specifically as related to its public health function and will suggest methods to improve its service in resource-poor settings. This article is offered not as a critique of the current practice that most pathologists find themselves working in globally, but to provide suggestions for improving perinatal pathology services, which could be implemented with the limited available resources and manpower most pathology departments currently have. In addition, we offer suggestions for graded improvements ("ramping up") over time.
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Affiliation(s)
- Drucilla J Roberts
- Department of Pathology, Massachusetts General Hospital, Boston, MA 02115, USA.
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Abstract
Effective training has been shown to improve perinatal care and outcome, decrease litigation claims and reduce midwifery sick leave. To be effective, training should be incentivised, in a realistic context, and delivered to inter-professional teams similar to those delivering actual care. Teamwork training is a useful addition, but it should be based on the characteristics of effective teamwork as derived from the study of frontline teams. Implementation of simulation and teamwork training is challenging, with constraints on staff time, facilities and finances. Local adoption and adaptation of effective programmes can help keep costs down, and make them locally relevant whilst maintaining effectiveness. Training programmes need to evolve continually in line with new evidence. To do this, it is vital to monitor outcomes and robustly evaluate programmes for their impact on patient care and outcome, not just on participants.
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Affiliation(s)
- Abi Smith
- Department of Women's Health, Southmead Hospital, Bristol BS10 5NB, UK.
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100
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