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Feng CS, Li SF, Ju HH. The application of the ICD-10 for antepartum stillbirth patients in a referral centre of Eastern China: a retrospective study from 2015 to 2022. BMC Pregnancy Childbirth 2024; 24:164. [PMID: 38408955 PMCID: PMC10895843 DOI: 10.1186/s12884-024-06313-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 02/01/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND The causes of some stillbirths are unclear, and additional work must be done to investigate the risk factors for stillbirths. OBJECTIVE To apply the International Classification of Disease-10 (ICD-10) for antepartum stillbirth at a referral center in eastern China. METHODS Antepartum stillbirths were grouped according to the cause of death according to the International Classification of Disease-10 (ICD-10) criteria. The main maternal condition at the time of antepartum stillbirth was assigned to each patient. RESULTS Antepartum stillbirths were mostly classified as fetal deaths of unspecified cause, antepartum hypoxia. Although more than half of the mothers were without an identified condition at the time of the antepartum stillbirth, where there was a maternal condition associated with perinatal death, maternal medical and surgical conditions and maternal complications during pregnancy were most common. Of all the stillbirths, 51.2% occurred between 28 and 37 weeks of gestation, the main causes of stillbirth at different gestational ages also differed. Autopsy and chromosomal microarray analysis (CMA) were recommended in all stillbirths, but only 3.6% received autopsy and 10.5% underwent chromosomal microarray analysis. CONCLUSIONS The ICD-10 is helpful in classifying the causes of stillbirths, but more than half of the stillbirths in our study were unexplained; therefore, additional work must be done. And the ICD-10 score may need to be improved, such as by classifying stillbirths according to gestational age. Autopsy and CMA could help determine the cause of stillbirth, but the acceptance of these methods is currently low.
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Affiliation(s)
- Chuan-Shou Feng
- Obstetrical department, Changzhou Women and Children Health Hospital, Nanjing Medical University, Changzhou, Jiangsu, China.
| | - Shu-Fen Li
- Obstetrical department, Changzhou Women and Children Health Hospital, Nanjing Medical University, Changzhou, Jiangsu, China
| | - Hui-Hui Ju
- Obstetrical department, Changzhou Women and Children Health Hospital, Nanjing Medical University, Changzhou, Jiangsu, China
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Devabhaktuni A, Pilliod RA, Caughey AB, Valent AM. The Risk of Perinatal Mortality in Nulliparous Women Compared to Primiparous Women at Term. Am J Perinatol 2024; 41:270-275. [PMID: 34666381 DOI: 10.1055/a-1673-0527] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The aim of this study was to determine the rate of perinatal mortality among nulliparous women compared with primiparous women at term and further characterize the risk of stillbirth by each week of gestation. STUDY DESIGN This is a retrospective cohort study of all term, singleton, nonanomalous births comparing perinatal mortality (stillbirth and neonatal death [NND]) between primiparous (parity = 1, with no history of abortion) and nulliparous (parity = 0) women who delivered in California between 2007 and 2011. Chi-squared tests and multivariable logistic regression analyses were performed to determine the frequencies and strength of association of perinatal mortality with parity, adjusting for maternal age, race, body mass index, pregestational diabetes, chronic hypertension, fetal sex, smoking status, and socioeconomic status. The risk of stillbirth at each gestational age at term was calculated using a pregnancies-at-risk life table method. A p-value less than 0.05 was used to indicate statistical significance. RESULTS Of 1,317,761 total deliveries, 765,995 (58.1%) were to nulliparous women and 551,766 (41.9%) were to primiparous women with one prior birth. Nulliparous women had increased odds of stillbirth (adjusted odds ratio [aOR], 3.30; 95% confidence interval [CI], 2.93-3.72) and NND (aOR, 1.54; 95% CI, 1.19-1.98) compared with primiparous women. The risk of stillbirth in nulliparous women was greater at every gestational age between 370/7 and 410/7 weeks compared with primiparous women. Nulliparous women also had increased odds of small for gestational age infants at less than 10% birth weight (aOR, 1.76; 95% CI, 1.72-1.79), less than 5% birth weight (aOR, 1.91; 95% CI, 1.86-1.98), and less than 3% birth weight (aOR, 2.02; 95% CI, 1.93-2.11). CONCLUSION Perinatal mortality is significantly greater in nulliparous women compared with primiparous women with term deliveries. These findings suggest that low-risk nulliparous women may require increased surveillance. There may be a role in improving maternal health by maximizing physiologic adaptation in nulliparous women. KEY POINTS · Parity is associated with perinatal mortality.. · Perinatal mortality is significantly greater in nulliparous women compared with primiparous women.. · The risk of stillbirth in nulliparous women is greater at every gestational age compared with primiparous women..
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Affiliation(s)
- Anuradha Devabhaktuni
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon
| | - Rachel A Pilliod
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon
| | - Aaron B Caughey
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon
| | - Amy M Valent
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon
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Jovanovic I, Ivanovic K, Kostic S, Tadic J, Dugalic S, Petronijevic M, Gojnic M, Petronijevic M, Vrzic-Petronijevic S. Intrauterine Fetal Death in Term Pregnancy-A Single Tertiary Clinic Study. Life (Basel) 2023; 13:2320. [PMID: 38137921 PMCID: PMC10745047 DOI: 10.3390/life13122320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 11/21/2023] [Accepted: 11/29/2023] [Indexed: 12/24/2023] Open
Abstract
INTRODUCTION Intrauterine fetal death (IUFD) is defined as death of the fetus after the 20th week of gestation. Despite regular monitoring the incidence of IUFD remains high. This study aims to assess the incidence and maternal conditions associated with IUFD over term pregnancies in a twelve-year period. MATERIALS AND METHODS A retrospective descriptive study was conducted on a population of women in whom IUFD was diagnosed in a term pregnancy during the period from January 2010 to December 2022. The study was at the Clinic for Obstetrics and Gynecology, University Clinic Centre of Serbia. The analyses included the number of deliveries, live births, and stillbirths, as well as maternal, fetal, and placental conditions associated with the risk of IUDF. The statistical analysis involved descriptive statistical methods and one sample proportion. RESULTS The average age of the patients was 30 years. Most patients had secondary and higher education, and 70% of patients had regular pregnancy monitoring; 53.33% were primiparous and pregnancies occurred spontaneously. IUFD mainly occurred in the 39th week of gestation. In total, 38.3% had one to two associated diseases, 5% more than three, and 58.33% were healthy. Recurrence of IUFD was reported by 10% of patients, while 8.33% had a history of spontaneous abortion. Over 80% of placental histopathological findings indicated some pathology (e.g., infarction, infections, placental abruption). CONCLUSIONS The most significant risk factors for IUFD in term pregnancies in our population during the study period were hypertensive syndrome in pregnancy, obesity and gestational diabetes. Pathological findings on the placenta were more common in our study group than is usually reported with infractions of placental tissue being the most common, even in healthy women.
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Affiliation(s)
- Ivana Jovanovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (K.I.); (S.K.); (S.D.); (M.P.); (M.G.); (M.P.)
- Clinic for Obstetrics and Gynecology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia;
| | - Katarina Ivanovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (K.I.); (S.K.); (S.D.); (M.P.); (M.G.); (M.P.)
- Clinic for Obstetrics and Gynecology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia;
| | - Sanja Kostic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (K.I.); (S.K.); (S.D.); (M.P.); (M.G.); (M.P.)
- Clinic for Obstetrics and Gynecology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia;
| | - Jasmina Tadic
- Clinic for Obstetrics and Gynecology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia;
| | - Stefan Dugalic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (K.I.); (S.K.); (S.D.); (M.P.); (M.G.); (M.P.)
- Clinic for Obstetrics and Gynecology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia;
| | - Milica Petronijevic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (K.I.); (S.K.); (S.D.); (M.P.); (M.G.); (M.P.)
| | - Miroslava Gojnic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (K.I.); (S.K.); (S.D.); (M.P.); (M.G.); (M.P.)
- Clinic for Obstetrics and Gynecology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia;
| | - Miloš Petronijevic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (K.I.); (S.K.); (S.D.); (M.P.); (M.G.); (M.P.)
- Clinic for Obstetrics and Gynecology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia;
| | - Svetlana Vrzic-Petronijevic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (K.I.); (S.K.); (S.D.); (M.P.); (M.G.); (M.P.)
- Clinic for Obstetrics and Gynecology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia;
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Salerno C, Melis B, Donno V, Guariglia G, Menichini D, Perrone E, Facchinetti F, Monari F. Risk factors for stillbirth at term: an Italian area-based, prospective cohort study. AJOG GLOBAL REPORTS 2023; 3:100269. [PMID: 37868824 PMCID: PMC10585316 DOI: 10.1016/j.xagr.2023.100269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023] Open
Abstract
BACKGROUND Stillbirth at term has great emotional impact on both parents and professionals. In developed countries, efforts to identify risk factors are mandatory to plan area-specific prevention strategies. OBJECTIVE The aim of the study was to identify independent risk factors that contribute to stillbirth at 37 weeks' gestation or later. STUDY DESIGN This was an area-based, prospective cohort study on pregnancy at term with enrolled from 2014 to 2021 in Emilia-Romagna, a north Italian region. Data were retrieved from both birth certificates and the Stillbirth Surveillance system database. To identify independent risk factors, a multivariate analysis using logistic regression was performed. A descriptive analysis of the causes of stillbirth is also reported. RESULTS In the observation period, 246,437 babies born at term (including 260 stillbirths, giving a rate of 1.06/1000) were considered. The risk factors independently associated with stillbirth were small for gestational age babies (odds ratio, 2.58; 95% confidence interval, 1.88-3.53), pregnancy achieved though fertility treatments (odds ratio, 2.01; 95% confidence interval, 1.15-3.51), and delayed access to pregnancy services (odds ratio, 1.56; 95% confidence interval, 1.10-2.22). In multipara, the presence of a previous stillbirth (odds ratio, 3.91; 95% confidence interval, 1.98-7.72) was also associated with an increased risk for recurrence. Early- rather than late-term was an additional risk factor. The most frequent causes of death were placental and cord disorders (61/260 and 56/260, respectively). However, 28.1% of cases remain unexplained. CONCLUSION The risks for stillbirth at term are known early in pregnancy or could be identified through tailored antenatal management, allowing effective preventive strategies to reduce preventable cases.
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Affiliation(s)
- Cristina Salerno
- Obstetrics and Gynecology Unit, Mother-Infant and Adult Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy (Drs Salerno, Melis, Donno, Guariglia, Facchinetti, and Monari)
| | - Beatrice Melis
- Obstetrics and Gynecology Unit, Mother-Infant and Adult Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy (Drs Salerno, Melis, Donno, Guariglia, Facchinetti, and Monari)
| | - Valeria Donno
- Obstetrics and Gynecology Unit, Mother-Infant and Adult Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy (Drs Salerno, Melis, Donno, Guariglia, Facchinetti, and Monari)
| | - Gloria Guariglia
- Obstetrics and Gynecology Unit, Mother-Infant and Adult Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy (Drs Salerno, Melis, Donno, Guariglia, Facchinetti, and Monari)
| | - Daniela Menichini
- International Doctorate School in Clinical and Experimental Medicine, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy (Dr Menichini)
| | - Enrica Perrone
- Emilia-Romagna Health and Welfare Directorate, Community Care Department, Bologna, Italy (Dr Perrone)
| | - Fabio Facchinetti
- Obstetrics and Gynecology Unit, Mother-Infant and Adult Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy (Drs Salerno, Melis, Donno, Guariglia, Facchinetti, and Monari)
| | - Francesca Monari
- Obstetrics and Gynecology Unit, Mother-Infant and Adult Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy (Drs Salerno, Melis, Donno, Guariglia, Facchinetti, and Monari)
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Carter SWD, Neubronner S, Su LL, Dashraath P, Mattar C, Illanes SE, Choolani MA, Kemp MW. Chorioamnionitis: An Update on Diagnostic Evaluation. Biomedicines 2023; 11:2922. [PMID: 38001923 PMCID: PMC10669668 DOI: 10.3390/biomedicines11112922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/20/2023] [Accepted: 10/25/2023] [Indexed: 11/26/2023] Open
Abstract
Chorioamnionitis remains a major cause of preterm birth and maternal and neonatal morbidity. We reviewed the current evidence for the diagnostic tests of chorioamnionitis and how this relates to clinical practice today. A comprehensive literature search and review was conducted on chorioamnionitis and intra-uterine inflammation. Data from randomized control trials and systematic reviews were prioritized. This review highlights that sterile inflammation plays an important role in chorioamnionitis and that the current tests for chorioamnionitis including clinical criteria, maternal plasma and vaginal biomarkers lack diagnostic accuracy. Concerningly, these tests often rely on detecting an inflammatory response after damage has occurred to the fetus. Care should be taken when interpreting current investigations for the diagnosis of chorioamnionitis and how they guide obstetric/neonatal management. There is an urgent need for further validation of current diagnostic tests and the development of novel, accurate, minimally invasive tests that detect subclinical intra-uterine inflammation.
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Affiliation(s)
- Sean W D Carter
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Samantha Neubronner
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore 117597, Singapore
| | - Lin Lin Su
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore 117597, Singapore
| | - Pradip Dashraath
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore 117597, Singapore
| | - Citra Mattar
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore 117597, Singapore
| | - Sebastián E Illanes
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
- Center for Biomedical Research and Innovation, Reproductive Biology Program, Universidad de los Andes, Santiago 111711, Chile
- IMPACT, Center of Interventional Medicine for Precision and Advanced Cellular Therapy, Santiago 8331150, Chile
| | - Mahesh A Choolani
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore 117597, Singapore
| | - Matthew W Kemp
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
- Women and Infants Research Foundation, King Edward Memorial Hospital, Perth, WA 6008, Australia
- Center for Perinatal and Neonatal Medicine, Tohoku University Hospital, Sendai 980-8574, Japan
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Jancsura MK, Schmella MJ, Helsabeck N, Gillespie SL, Roberts JM, Conley YP, Hubel CA. Inflammatory markers are elevated in early pregnancy, but not late pregnancy, in women with overweight and obesity that later develop preeclampsia. Am J Reprod Immunol 2023; 90:e13763. [PMID: 37641371 PMCID: PMC10465815 DOI: 10.1111/aji.13763] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/27/2023] [Accepted: 07/25/2023] [Indexed: 08/31/2023] Open
Abstract
PROBLEM Obesity and preeclampsia both involve a pathological inflammatory response, which may be how obesity increases preeclampsia risk. Previous studies have failed to assess robust measurements of inflammatory markers across gestation, specifically in overweight/ obese women in the context of preeclampsia. METHOD OF STUDY We measured 20 inflammatory markers in plasma via multiplex assay (ThermoFisher Inflammation 20 plex Human ProcartaPlex Panel) across the three trimesters of pregnancy in an existing cohort of overweight and obese women who developed preeclampsia (n = 37) and without preeclampsia (n = 74). Mann-Whitney U tests examined differences in inflammatory marker concentrations between cases and controls. Repeated measures ANOVA tests were used to explore differences in inflammatory marker concentrations over time within cases and controls. RESULTS Pro-inflammatory markers (IL-1α, IL-1β, IL-6, IFN-α, IFN-γ, GM-CSF, IL-12p70, IL-17α, TNF-α, IL-8) and anti-inflammatory markers (IL-4, IL-10, IL-13) were higher in the first and second trimester in participants who later developed preeclampsia compared to those who did not (p < .05). Only TNF-α and IL-8 remained elevated in the third trimester. Inflammatory markers did not change across pregnancy in preeclampsia cases but did increase across pregnancy in controls. CONCLUSION Our findings diverge from prior studies, predominantly of non-obese women, that report lower circulating concentrations of anti-inflammatory cytokines in preeclampsia versus normotensive pregnancy, particularly by late pregnancy. We posit that women with overweight and obesity who develop preeclampsia entered pregnancy with a heightened pro-inflammatory state likely related to obesity, which increased risk for preeclampsia. Further studies are needed to investigate if inflammatory maker profiles differ between obese and non-obese women.
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Affiliation(s)
- McKenzie K Jancsura
- College of Nursing Martha S. Pitzer Center for Women, Children and Youth, The Ohio State University, Columbus, USA
| | | | | | - Shannon L Gillespie
- College of Nursing Martha S. Pitzer Center for Women, Children and Youth, The Ohio State University, Columbus, USA
| | - James M Roberts
- Departments of Obstetrics Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, USA
- Department of Epidemiology and Clinical and Translational Research, University of Pittsburgh School of Medicine, Pittsburgh, USA
- Magee-Womens Research Institute, Pittsburgh, United States
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, USA
| | - Carl A Hubel
- Departments of Obstetrics Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, USA
- Magee-Womens Research Institute, Pittsburgh, United States
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Komboigo BE, Zamane H, Coulibaly A, Sib SR, Thiombiano M, Thieba B. Factors associated with intrapartum stillbirth in a tertiary teaching hospital in Burkina Faso. Front Glob Womens Health 2023; 4:1038817. [PMID: 37077727 PMCID: PMC10106769 DOI: 10.3389/fgwh.2023.1038817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 03/20/2023] [Indexed: 04/05/2023] Open
Abstract
IntroductionIntrapartum stillbirth is an indicator of health and community development.ObjectiveTo identify the risk factors associated with intrapartum stillbirth in a tertiary teaching hospital in Burkina Faso.Patients and methodsA case-control study conducted from January 1 to August 30, 2019. Cases were defined as patients admitted to Yalgado Ouedraogo teaching hospital (YOTH) with a live fetus of at least 28 weeks’ gestation and who gave birth to an intrapartum stillborn, a fetus delivered without any signs of life in the first minute postpartum. Controls were defined as patients who delivered a live newborn. Study controls were gradually recruited and matched to cases. For each case, two controls were recruited and matched according to criteria such as delivery route and day of delivery. Data were cleaned in Epidata and exported to Stata for analysis. Variables with a p < 0.05 significance level in the multivariable regression were retained. Odds ratio (OR) and 95% confidence intervals are reported.ResultsEighty-three intrapartum stillbirths were documented among a total of 4,122 deliveries, a stillbirth rate of 20.1 per 1,000 births. There was a statistically significant association between intrapartum stillbirth and prior caesarean section (p = 0.045), multiparity (p = 0.03), the receipt of antenatal care (ANC) by a nurse (p = 0.005) and the disuse of the partogram (p = 0.004). We did not find a significant association between the number of ANC consultations performed (p = 0.3), whether membranes were ruptured at admission (p = 0.6), the duration of labor (p = 0.6) and intrapartum fetal death. Multivariate analysis showed that patient referral to another heath facility (OR: 3.33; 95% IC: 1.56, 7.10), no obstetric ultrasound performed (OR: 3.16; 95% IC: 2.11, 4.73), birth weight less than 2,500 g (OR: 7.49; 95% IC: 6.40, 8.76) were significantly associated with intrapartum stillbirth.ConclusionSpecific interventions must be taken to identify these risk factors of intrapartum stillbirth in order to ensure better and appropriate management.
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Affiliation(s)
- Bewendin Evelyne Komboigo
- Higher Institute of Health Sciences, Nazi Boni University, Bobo-Dioulasso, Burkina Faso
- Department of Gynecology, Obstetrics and Reproductive Medicine, Sourô Sanou University Hospital Center, Bobo-Dioulasso, Burkina Faso
- Correspondence: Komboigo Bewendin Evelyne
| | - Hyacinthe Zamane
- Health Science Training and Research Unit, Joseph Ki-Zerbo University, Ouagadougou, Burkina Faso
- Department of Gynecology-Obstetrics, Yalgado Ouedraogo Teaching Hospital, Ouagadougou, Burkina Faso
| | - Abou Coulibaly
- Research Institute of Health Sciences (IRSS), Ouagadougou, Burkina Faso
| | - Sansan Rodrigue Sib
- Obstetrics Gynecology Department, Regional Teaching Hospital of Ouahygouya, Ouahigouya, Burkina Faso
| | - Madina Thiombiano
- Department of Gynecology-Obstetrics, Regional Hospital Center of Koudougou, Koudougou, Burkina Faso
| | - Blandine Thieba
- Health Science Training and Research Unit, Joseph Ki-Zerbo University, Ouagadougou, Burkina Faso
- Department of Gynecology-Obstetrics, Yalgado Ouedraogo Teaching Hospital, Ouagadougou, Burkina Faso
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Winterstein AG, Thai TN, Nduaguba S, Smolinski NE, Wang X, Sahin L, Krefting I, Gelperin K, Bird ST, Rasmussen SA. Risk of fetal or neonatal death or neonatal intensive care unit admission associated with gadolinium magnetic resonance imaging exposure during pregnancy. Am J Obstet Gynecol 2022; 228:465.e1-465.e11. [PMID: 36241080 DOI: 10.1016/j.ajog.2022.10.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 09/30/2022] [Accepted: 10/05/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Concerns have been raised about prenatal exposure to magnetic resonance imaging with gadolinium-based contrast agents because of nonclinical findings of gadolinium retention in fetal tissue and 1 population-based study reporting an association with adverse pregnancy outcomes. OBJECTIVE This study aimed to evaluate the association between prenatal magnetic resonance imaging exposure with and without gadolinium-based contrast agents and fetal and neonatal death and neonatal intensive care unit admission. STUDY DESIGN We constructed a retrospective cohort of >11 million Medicaid-covered pregnancies between 1999 and 2014 to evaluate the association between prenatal magnetic resonance imaging exposure with and without gadolinium-based contrast agents and fetal and neonatal death (primary endpoint) and neonatal intensive care unit admissions (secondary endpoint). Medicaid claims data were linked to medical records, Florida birth and fetal death records, and the National Death Index to validate the outcomes and gestational age estimates. Pregnancies with multiples, concurrent cancer, teratogenic drug exposure, magnetic resonance imaging focused on fetal or pelvic evaluation, undetermined gadolinium-based contrast agent use, or those preceded by or contemporaneous with congenital anomaly diagnoses were excluded. We adjusted for potential confounders with standardized mortality ratio weighting using propensity scores. RESULTS Among 5991 qualifying pregnancies, we found 11 fetal or neonatal deaths in the gadolinium-based contrast agent magnetic resonance imaging group (1.4%) and 73 in the non-gadolinium-based contrast agent magnetic resonance imaging group (1.4%) with an adjusted relative risk of 0.73 (95% confidence interval, 0.34-1.55); the neonatal intensive care unit admission adjusted relative risk was 1.03 (0.76-1.39). Sensitivity analyses investigating the timing of magnetic resonance imaging or repeat magnetic resonance imaging exposure during pregnancy and simulating the impact of exposure misclassification corroborated these results. CONCLUSION This study addressed the safety concerns related to prenatal exposure to gadolinium-based contrast agents used in magnetic resonance imaging and the risk thereof on fetal and neonatal death or the need for neonatal intensive care unit admission. Although the results on fatal or severe acute effects are reassuring, the impact on subacute outcomes was not evaluated.
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Affiliation(s)
- Almut G Winterstein
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL; Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, FL; Department of Epidemiology, College of Medicine and College of Public Health and Health Professions, University of Florida, Gainesville, FL.
| | - Thuy N Thai
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL; Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, FL; Faculty of Pharmacy, Ho Chi Minh City University of Technology (HUTECH), Ho Chi Minh City, Vietnam
| | - Sabina Nduaguba
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL; Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, FL
| | - Nicole E Smolinski
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL; Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, FL
| | - Xi Wang
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL
| | - Leyla Sahin
- Division of Pediatrics and Maternal Health, Office of New Drugs, Center for Drug Evaluation and Research (CDER), Food and Drug Administration (FDA), Silver Spring, MD
| | - Ira Krefting
- Division of Imaging and Radiation Medicine, Office of New Drugs, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD
| | - Kate Gelperin
- Division of Epidemiology, Office of Surveillance and Epidemiology, CDER, FDA, Silver Spring, MD
| | - Steven T Bird
- Division of Epidemiology, Office of Surveillance and Epidemiology, CDER, FDA, Silver Spring, MD
| | - Sonja A Rasmussen
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, FL; Department of Epidemiology, College of Medicine and College of Public Health and Health Professions, University of Florida, Gainesville, FL; Departments of Pediatrics, College of Medicine, University of Florida, Gainesville, FL; Obstetrics and Gynecology, College of Medicine, University of Florida, Gainesville, FL
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Darouich S, Masmoudi A. Value of Placental Examination in the Diagnostic Evaluation of Stillbirth. Fetal Pediatr Pathol 2022; 41:535-550. [PMID: 33263451 DOI: 10.1080/15513815.2020.1850952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
ObjectiveThe aim was to assess the contribution of placental examination in the etiologic investigation of stillbirth. Materials and Methods: A retrospective review of stillbirths that occurred after 14 weeks gestation was conducted for a one-year period. Twin pregnancies and fetuses without placentas were excluded. According to the fetoplacental examination, stillbirths were classified into etiologic groups. Results: A total of 147 stillbirths were selected. They were associated with placental, materno-fetal, fetal and multiple causes in 89 cases (61%), 23 cases (16%), 14 cases (9%) and 13 cases (9%), respectively. Unexplained stillbirths were observed in 8 cases (5%). Placental abnormalities were identified in 132/147 cases (90%). They were consistent with vascular, inflammatory and developmental lesions in 82/132 cases (61%), 28/132 cases (21%) and 18/132 cases (13%), respectively. Conclusion: Placental lesions were the main causes of stillbirth and were predominantly of vascular type including chronic villous hypoxia-ischemia and funicular anomalies.
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Affiliation(s)
- Sihem Darouich
- LR99ES10 Laboratory of Human genetics, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.,Fetopathology Unit, Hospital Habib Bougatfa, Bizerte, Tunisia
| | - Aida Masmoudi
- Department of Embryo-Fetopathology, Maternity and Neonatology Center, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
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10
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Mengistu S, Debella A, Mulatu T, Mesfin F, Danusa KT, Dheresa M. Stillbirth and Associated Factors Among Women Who Gave Birth at Hiwot Fana Specialized University Hospital, Harar, Eastern Ethiopia. Front Pediatr 2022; 10:820308. [PMID: 35633972 PMCID: PMC9133714 DOI: 10.3389/fped.2022.820308] [Citation(s) in RCA: 1] [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] [Received: 11/22/2021] [Accepted: 03/28/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Stillbirth, which accounts for half of all the perinatal mortality, is not counted on policy, program, and investment agendas around the globe. It has been underestimated public health burden, particularly in developing countries. Ethiopia is among the top countries with a large prevalence of stillbirth in the world. However, there is a dearth of study on the current magnitude of stillbirth in the study area. Therefore, this study intended to assess the prevalence of stillbirth and its associated factors to bridge the gap. METHODS A hospital-based retrospective study was conducted from 1 to 28 February 2019 and data were collected by reviewing the chart records of all the women who gave birth in the past 2 years (January 2016 to December 2018) at Hiwot Fana Specialized University Hospital. Data were entered into EpiData version 4.2.0.0 software and transported to SPSS version 23 for analysis. Descriptive statistics such as frequency, mean, and SDs were generated. Determinants of stillbirth were analyzed using a binary logistic regression and presented by adjusted odds ratio (AOR) with a 95% CI. RESULTS The prevalence of stillbirth was 14.5% (95% CI: 11.7%, 17.6%). Low birth weight (AOR = 2.42, 95% CI: 1.23-4.76), prematurity (AOR = 2.10, 95% CI: 1.10-4.01), premature rupture of membranes (AOR = 2.08, 95% CI: 1.14-3.77), antepartum hemorrhage (AOR = 3.33, 95% CI: 1.66-6.67), obstructed labor (AOR = 2.87, 95% CI: 1.48-5.56), and preeclampsia (AOR = 2.91, 95% CI: 1.28-6.62) were an independently associated with stillbirth. CONCLUSION The prevalence of stillbirth in this study was high. Low birth weight, preterm birth, premature rupture of membranes, antepartum hemorrhage, obstructed labor, and preeclampsia were independently associated with a stillbirth. Therefore, much study is needed involving different stakeholders to reduce stillbirths by improving the health status of women through the provision of quality maternal care including referral systems.
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Affiliation(s)
- Seble Mengistu
- Hiwot Fana Specialized University Hospital, College of Health and Medical Science, Haramaya University, Dire Dawa, Ethiopia
| | - Adera Debella
- School of Nursing and Midwifery, College of Health and Medical Science, Haramaya University, Dire Dawa, Ethiopia
| | - Teshale Mulatu
- School of Nursing and Midwifery, College of Health and Medical Science, Haramaya University, Dire Dawa, Ethiopia
| | - Firehiwot Mesfin
- School of Public Health, College of Health and Medical Science, Haramaya University, Dire Dawa, Ethiopia
| | - Kababa Temesgen Danusa
- Department of Midwifery, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Merga Dheresa
- School of Nursing and Midwifery, College of Health and Medical Science, Haramaya University, Dire Dawa, Ethiopia
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Tesfay N, Legesse F, Kebede M, Woldeyohannes F. Determinants of stillbirth among reviewed perinatal deaths in Ethiopia. Front Pediatr 2022; 10:1030981. [PMID: 36518781 PMCID: PMC9743177 DOI: 10.3389/fped.2022.1030981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 11/07/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The global burden of stillbirth has declined over time. However, the problem is still prominent in South Asian and Sub-Saharan African countries. Ethiopia is one of the top stillbirth-reporting countries worldwide. Despite several measures taken to reduce the burden of stillbirth; the pace of decline was not as good as the post-neonatal death. Thus, this study is aimed at identifying potential factors related to stillbirth in Ethiopia based on nationally reviewed perinatal deaths. METHOD The national perinatal death surveillance data were used for this study. A total of 3,814 reviewed perinatal death were included in the study. Two model families,namely generalized estimating equation, and alternating logistic regression models from marginal model family were employed to investigate the risk factors of stillbirth. The alternating logistic regression model was selected as the best fit for the final analysis. RESULT Among reviewed perinatal deaths nearly forty percent (37.4%) were stillbirths. The findings from the multivariate analysis demonstrated that the place of birth (in transit and at home), cause of death (infection, and congenital and chromosomal abnormalities), maternal health condition (women with complications of pregnancy, placenta, and cord), delay one (delay in deciding to seek care) and delay three (delay in receiving adequate care) were associated with an increased risk of having a stillbirth. On the other hand, maternal education (women with primary and above education level) and the type of health facility (women who were treated in secondary and tertiary health care) were associated with a decreased risk of having a stillbirth. CONCLUSION The study identified that both individual (place of delivery, cause of death, maternal health condition, maternal education, and delay one) and facility level (type of health facility and delay three) factors contributed to stillbirth outcome. Therefore, policies that are aimed at encouraging institutional delivery, improving health seeking behavior, and strengthening facility-level readiness should be devised to reduce the high burden of stillbirth in Ethiopia.
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Affiliation(s)
- Neamin Tesfay
- Center of Public Emergency Management, Ethiopian Public Health Institutes, Addis Ababa, Ethiopia
| | - Frehiwot Legesse
- Center of Public Emergency Management, Ethiopian Public Health Institutes, Addis Ababa, Ethiopia
| | - Mandefro Kebede
- Center of Public Emergency Management, Ethiopian Public Health Institutes, Addis Ababa, Ethiopia
| | - Fitsum Woldeyohannes
- Health Financing Program, Clinton Health Access Initiative, Addis Ababa, Ethiopia
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Analysis of Maternal and Neonatal Complications in a Group of Patients with Gestational Diabetes Mellitus. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57111170. [PMID: 34833388 PMCID: PMC8619358 DOI: 10.3390/medicina57111170] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 10/14/2021] [Accepted: 10/25/2021] [Indexed: 12/22/2022]
Abstract
Background and Objectives: Gestational diabetes mellitus (GDM) represents one of the most common complications during pregnancy, being associated with numerous maternal and neonatal complications. The study aimed to analyze maternal and neonatal complications associated with GDM. The risk factors of GDM and of the maternal and neonatal complications were studied in order to prevent their occurrence. Materials and Methods: The study included 97 women in the study, who underwent an oral glucose tolerance test (OGTT) between weeks 24–28 of pregnancy, consequently being divided into two groups: pregnant women with and without GDM. Statistical analysis was performed using the SPSS 26.0 software and MATLAB fitglm, the results being considered statistically significant if p < 0.05. Results: We observed statistically significant differences between the group of women with and without GDM, regarding gestational hypertension (17.6% vs. 0%), preeclampsia (13.72% vs. 0%), and cesarean delivery (96.1% vs. 78,3%). Data on the newborn and neonatal complications: statistically significant differences were recorded between the two groups (GDM vs. no GDM) regarding the average weight at birth (3339.41 ± 658.12 g vs. 3122.83 ± 173.67 g), presence of large for gestational age (21.6% vs. 0%), macrosomia (13.7% vs. 0%), excessive fetal growth (35.3% vs. 0%), respiratory distress (31.4% vs. 0%), hospitalization for at least 24 h in the Neonatal Intensive Care Unit (9.80% vs. 0%), and APGAR score <7 both 1 and 5 min following birth (7.8% vs. 0%). Additionally, the frequency of neonatal hypoglycemia and hyperbilirubinemia was higher among newborns from mothers with GDM. Conclusions: The screening and diagnosis of GDM is vital, and appropriate management is required for the prevention of maternal and neonatal complications associated with GDM. It is also important to know the risk factors for GDM and attempt to prevent their appearance.
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Stanhope KK, Adeyemi DI, Li T, Johnson T, Boulet SL. The relationship between the neighborhood built and social environment and hypertensive disorders of pregnancy: A scoping review. Ann Epidemiol 2021; 64:67-75. [PMID: 34547447 DOI: 10.1016/j.annepidem.2021.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 09/03/2021] [Accepted: 09/12/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Theory and limited empirical research suggest that the neighborhood environment influences maternal health outcomes. The goal of this scoping review is to summarize extant research considering the impact of the built and social environment of resident neighborhood on hypertensive disorders of pregnancy (HDP) globally. METHODS We performed a systematic search of the literature using four databases, PubMed, Web of Science, CINAHL, and Embase on July 15, 2020. We excluded articles not in English, that did not consider one or more HDP as a primary or secondary outcome, and that did not include an element of the neighborhood built or social environment as an exposure. We applied a modified version of the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies to evaluate quality of included studies. RESULTS Our search identified 11,385 unique abstracts for screening. Following exclusions, we included 64 articles in the final review. The majority of articles measured an element of the built environment (70.3% (44)), most commonly traffic-related air pollution (42.2% (27)). A third of articles (31.3% (20)) considered an element of the neighborhood social environment, most commonly neighborhood deprivation (10.9% (7)). Global quality ratings were mostly moderate (29.7% (19)) or weak (68.8% (44)), primarily due to inattention to neighborhood-level confounding. CONCLUSION Critical gaps remain in understanding how the resident neighborhood may impact HDP. Future research should focus on designing high-quality studies incorporating elements of both the built and social environment to holistically understand how context may impact maternal health.
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Affiliation(s)
- Kaitlyn K Stanhope
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA,.
| | - Deborah I Adeyemi
- Department of Epidemiology, Rollin School of Public Health, Emory University, Atlanta, GA
| | - Tanya Li
- Emory College of Arts and Sciences, Emory University, Atlanta, GA
| | | | - Sheree L Boulet
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA
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14
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Predictive Model for Late Stillbirth Among Antenatal Hypertensive Women. J Obstet Gynaecol India 2021; 72:96-101. [PMID: 35928077 PMCID: PMC9343536 DOI: 10.1007/s13224-021-01561-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 08/17/2021] [Indexed: 01/02/2023] Open
Abstract
Objective To develop a predictive model for late stillbirth among women with hypertensive disorders of pregnancy (HDP) in low- and middle-income countries. Materials and Methods Study was part of the WHO newborn birth defect (NBBD) project and included all stillbirths occurring in the facility from November 2015 to December 2020. The age and parity matched subjects with HDP having live birth were taken as controls. All significant predictors were analyzed and a predictive model was developed. Results Out of 69,007 deliveries, 1691(24.5/1000) were stillborn. HDP was seen in (390/1691, 23.0%), in 265/390 (67.4%) cases it occurred at or after 28 weeks of gestation and were included as cases. On comparing the cases with controls, the significant factors were estimated fetal weight less than 2000 gms (P < 0.001, OR 10.3), poor antenatal care (p < 0.001, OR-5.9), family history of hypertension (p < 0.018, OR-4.4) and the presence of gestational hypertension (p = 0.001, OR 2.2). The predictive model had sensitivity and specificity of 80.3% and 70.03%, respectively, the receiver operating curve showed the area under the curve(AUC) in the range of good prediction (0.846). Conclusion The predictive model could play a potential role in stillbirth prevention in women with HDP in low- and middle-income countries. Supplementary Information The online version contains supplementary material available at 10.1007/s13224-021-01561-3.
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15
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Caniglia EC, Abrams J, Diseko M, Mayondi G, Mabuta J, Makhema J, Mmalane M, Lockman S, Bernstein A, Zash R, Shapiro R. Seasonality of adverse birth outcomes in women with and without HIV in a representative birth outcomes surveillance study in Botswana. BMJ Open 2021; 11:e045882. [PMID: 34479931 PMCID: PMC8420660 DOI: 10.1136/bmjopen-2020-045882] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Sub-Saharan Africa has the largest number of people with HIV, one of the most severe burdens of adverse birth outcomes globally and particular vulnerability to climate change. We examined associations between seasonality and adverse birth outcomes among women with and without HIV in a large geographically representative birth outcomes surveillance study in Botswana from 2015 to 2018. METHODS We evaluated stillbirth, preterm delivery, very preterm delivery, small for gestational age (SGA), very SGA, and combined endpoints of any adverse or severe birth outcome. We estimated the risk of each outcome by month and year of delivery, and adjusted risks ratios (ARRs) of outcomes during the early wet (1 November-15 January), late wet (16 January-31 March) and early dry (1 April-15 July) seasons, compared with the late dry (16 July-31 October) season. Analyses were conducted overall and separately by HIV status. RESULTS Among 73 178 women (24% with HIV), the risk of all adverse birth outcomes peaked in November-January and reached low points in September. Compared with the late dry season, the ARRs for any adverse birth outcome were 1.03 (95% CI 1.00 to 1.06) for the early dry season, 1.08 (95% CI 1.04 to 1.11) for the early wet season and 1.07 (95% CI 1.03 to 1.10) for the late wet season. Comparing the early wet season to the late dry season, we found that ARRs for stillbirth and very preterm delivery were higher in women with HIV (1.23, 95% CI 0.96 to 1.59, and 1.33, 95% CI 1.10 to 1.62, respectively) than in women without HIV (1.07, 95% CI 0.91 to 1.26, and 1.19, 95% CI 1.04 to 1.36, respectively). CONCLUSIONS We identified a modest association between seasonality and adverse birth outcomes in Botswana, which was greatest among women with HIV. Understanding seasonal patterns of adverse birth outcomes and the role of HIV status may allow for mitigation of their impact in the face of seasonal extremes related to climate change.
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Affiliation(s)
- Ellen C Caniglia
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jasmyn Abrams
- Department of Population Health, NYU Langone Health, New York, New York, USA
| | - Modiegi Diseko
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Gloria Mayondi
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Judith Mabuta
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Joseph Makhema
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Mompati Mmalane
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Shahin Lockman
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
- Department of Infectious Disease, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Aaron Bernstein
- Immunology and Infectious Diseases, Center for Climate, Health, and the Global Environment, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Rebecca Zash
- Department of Infectious Diseases, BIDMC, Boston, Massachusetts, USA
| | - Roger Shapiro
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
- Immunology and Infectious Diseases, Center for Climate, Health, and the Global Environment, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Abebe H, Shitu S, Workye H, Mose A. Predictors of stillbirth among women who had given birth in Southern Ethiopia, 2020: A case-control study. PLoS One 2021; 16:e0249865. [PMID: 33939713 PMCID: PMC8092801 DOI: 10.1371/journal.pone.0249865] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 03/26/2021] [Indexed: 11/18/2022] Open
Abstract
Background Although the rate of stillbirth has decreased globally, it remains unacceptably high in low- and middle-income countries. Only ten countries including Ethiopia attribute more than 65% of global burden of still birth. Ethiopia has the 7th highest still birth rate in the world. Identifying the predictors of stillbirth is critical for developing successful interventions and monitoring public health programs. Although certain studies have assessed the predictors of stillbirth, they failed in identify the proximate predictors of stillbirth. In addition, the inconsistent findings in identify the predictors of stillbirth, and the methodological limitations in previously published works are some of the gaps. Therefore, this study aimed to identify the predictors of stillbirth among mothers who gave birth in six referral hospitals in Southern, Ethiopia. Methods A hospital-based unmatched case-control study was conducted in six referral hospitals in Southern, Ethiopia from October 2019 to June 2020. Consecutive sampling techniques and simple random techniques were used to recruit cases and controls respectively. A structured standard tool was used to identify the predictors of stillbirth. Data were entered into Epi Info 7 and exported to SPSS 23 for analysis. A multivariable logistic regression model was used to identify the independent predictors of stillbirth. The goodness of fit was tested using the Hosmer and Lemeshow goodness-of-fit. In this study P-value < 0.05 was considered to declare a result as a statistically significant association. Results In this study 138 stillbirth cases and 269 controls were included. Women with multiple pregnancy [AOR = 2.98, 95%CI: 1.39–6.36], having preterm birth [AOR = 2.83, 95%CI: 1.58–508], having cesarean mode of delivery [AOR = 3.19, 95%CI: 1.87–5.44], having no ANC visit [AOR = 4.17, 95%CI: 2.38–7.33], and being hypertensive during pregnancy [AOR = 3.43, 95%CI: 1.93–6.06] were significantly associated with stillbirth. Conclusions The predictors of stillbirth identified are manageable and can be amenable to interventions. Therefore, strengthening maternal antenatal care utilization should be encouraged by providing appropriate information to the mothers. There is a need to identify, screen, and critically follow high-risk mothers: those who have different complications during pregnancy, and those undergoing cesarean section due to different indications.
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Affiliation(s)
- Haimanot Abebe
- Department of Public Health, College of Health Sciences and Medicine, Wolkite University, Wolkite, Ethiopia
- * E-mail:
| | - Solomon Shitu
- Department of Midwifery, College of Health Sciences and Medicine, Wolkite University, Wolkite, Ethiopia
| | - Haile Workye
- Department of Nursing, College of Health Sciences and Medicine, Wolkite University, Wolkite, Ethiopia
| | - Ayenew Mose
- Department of Midwifery, College of Health Sciences and Medicine, Wolkite University, Wolkite, Ethiopia
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Abstract
BACKGROUND There is limited literature on adequacy of prenatal care during pregnancy especially in case of stillbirth. METHODS This retrospective study consisted of 103 patients with stillbirths and 197 patients with live births. The adequacy of prenatal care utilization index (APNCU) was used to determine prenatal care adequacy. [Canadian Task Force classification II-2]. RESULTS Among high-risk patients, the APNCU categories of inadequate (OR:3.81, 95% CI:1.16, 12.57, p<0.05) and adequate plus (OR:2.58, 95% CI:1.23, 5.38, p<0.05) were each significantly associated with greater odds for stillbirth. Diabetes, multifetal gestations, and fetal anomalies were each significantly associated with increased odds for stillbirth. CONCLUSIONS Our findings emphasize the importance of clinicians in the role of providing appropriate prenatal care in the prevention of stillbirth. Clinicians also should realize that even with the best care approach of adequate plus prenatal care, certain high-risk patients will still be at risk for stillbirth.
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Affiliation(s)
- Shailja Dayal
- Department of Obstetrics & Gynecology, Nassau University Medical Center, East Meadow, NY, USA
| | - Joshua Fogel
- Department of Obstetrics & Gynecology, Nassau University Medical Center, East Meadow, NY, USA - .,Department of Business Management, Brooklyn College of the City University of New York, Brooklyn, NY, USA
| | - Robert Griggs
- Department of Obstetrics & Gynecology, Nassau University Medical Center, East Meadow, NY, USA
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Scher MS. "The First Thousand Days" Define a Fetal/Neonatal Neurology Program. Front Pediatr 2021; 9:683138. [PMID: 34408995 PMCID: PMC8365757 DOI: 10.3389/fped.2021.683138] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 05/27/2021] [Indexed: 01/11/2023] Open
Abstract
Gene-environment interactions begin at conception to influence maternal/placental/fetal triads, neonates, and children with short- and long-term effects on brain development. Life-long developmental neuroplasticity more likely results during critical/sensitive periods of brain maturation over these first 1,000 days. A fetal/neonatal program (FNNP) applying this perspective better identifies trimester-specific mechanisms affecting the maternal/placental/fetal (MPF) triad, expressed as brain malformations and destructive lesions. Maladaptive MPF triad interactions impair progenitor neuronal/glial populations within transient embryonic/fetal brain structures by processes such as maternal immune activation. Destructive fetal brain lesions later in pregnancy result from ischemic placental syndromes associated with the great obstetrical syndromes. Trimester-specific MPF triad diseases may negatively impact labor and delivery outcomes. Neonatal neurocritical care addresses the symptomatic minority who express the great neonatal neurological syndromes: encephalopathy, seizures, stroke, and encephalopathy of prematurity. The asymptomatic majority present with neurologic disorders before 2 years of age without prior detection. The developmental principle of ontogenetic adaptation helps guide the diagnostic process during the first 1,000 days to identify more phenotypes using systems-biology analyses. This strategy will foster innovative interdisciplinary diagnostic/therapeutic pathways, educational curricula, and research agenda among multiple FNNP. Effective early-life diagnostic/therapeutic programs will help reduce neurologic disease burden across the lifespan and successive generations.
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Affiliation(s)
- Mark S Scher
- Division of Pediatric Neurology, Department of Pediatrics, Fetal/Neonatal Neurology Program, Emeritus Scholar Tenured Full Professor in Pediatrics and Neurology, Case Western Reserve University School of Medicine, Cleveland, OH, United States
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Ranjbaran M, Mohammadi R, Yaseri M, Kamari M, Habibelahi A, Yazdani K. Effect of ambient air pollution and temperature on the risk of stillbirth: a distributed lag nonlinear time series analysis. JOURNAL OF ENVIRONMENTAL HEALTH SCIENCE & ENGINEERING 2020; 18:1289-1299. [PMID: 33312643 PMCID: PMC7721760 DOI: 10.1007/s40201-020-00547-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 09/21/2020] [Indexed: 05/09/2023]
Abstract
OBJECTIVES This study aimed to determine the effect of ambient air pollution and temperature on stillbirth in Tehran. METHODS In this time-series study, the effect of O3 (ppb), CO (ppm), NO2 (ppb), SO2 (ppb), PM2.5 (μg/m3), and minimum, maximum, and mean daily temperature (°C) on stillbirth was evaluated in Tehran, Iran between March 2015 and March 2018. Using a quasi-Poisson regression model in combination with a Distributed Lag Non-linear Models (DLNM), the Relative Risk (RR) was estimated through comparing the high temperature (99th, 95th, and 75th percentiles) and low temperature (1st, 5th, and 25th percentiles) with the median. The effect of air pollution was estimated for each 1-, 5-, or 10-unit increase in the concentration during lags (days) 0-21. RESULTS Among air pollutants, only a 5-ppm increase in the SO2 concentration in lag 0 increased the risk of stillbirth significantly (RR = 1.062; 1.002-1.125). The largest effect of heat was observed while comparing the 99th percentile of minimum daily temperature (26.9 °C) with the median temperature (13.2 °C), which was not statistically significant (RR = 1.25; 0.95-1.65). As for cold, a non-significant protective effect was observed while comparing the 1st percentile of maximum daily temperature (3.1 °C) with the median temperature (23.2 °C) (RR = 0.92; 0.72-1.19). CONCLUSION Each 5-ppm increase in the mean daily SO2 in lag 0 increased the risk of stillbirth by 6% while other air pollutants had no significant effects on stillbirth. In lags 0 and 1, the heat increased the risk of stillbirth while the cold had protective effects, which were not statistically significant.
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Affiliation(s)
- Mehdi Ranjbaran
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- School of Public Health, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Rasool Mohammadi
- Department of Biostatistics and Epidemiology, School of Public Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
- Nutritional Health Research Center, Health and Nutritional Department, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Mehdi Yaseri
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Kamari
- Deputy of Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Kamran Yazdani
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Iddi S, Kadengye DT, Kiwuwa-Muyingo S, Mutua MK, Asiki G. Associated factors of pregnancy loss in two urban slums of Nairobi: A generalized estimation equations approach. GLOBAL EPIDEMIOLOGY 2020. [DOI: 10.1016/j.gloepi.2020.100030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Burden of stillbirths and associated factors in Yirgalem Hospital, Southern Ethiopia: a facility based cross-sectional study. BMC Pregnancy Childbirth 2020; 20:591. [PMID: 33023508 PMCID: PMC7539424 DOI: 10.1186/s12884-020-03296-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 09/29/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Stillbirth is an adverse pregnancy outcome of public health importance causing considerable psychosocial burden on parents and their family. Studies on stillbirth are scarce in southern Ethiopia. An assessment of stillbirths and associated factors in health care settings helps in devising strategies for tailored interventions. Therefore, we assessed the burden of stillbirths and associated factors in Yirgalem Hospital, southern Ethiopia. METHODS A facility based cross-sectional study was conducted between 1 and 2015 and 30 July 2016. We randomly selected medical records of pregnant women from a hospital delivery registry. Bivariate analysis was employed to assess the association between independent and dependent variables using chi-square with significant p-value. Multivariate logistic regression was used to identify independent risk factors for stillbirths and to control for confounding variables. RESULTS Of 374 reviewed records of pregnant women, 370 were included for the study. The magnitude of stillbirths was 92 per 1000 births. Fifteen (44.1%) of fetal deaths occurred after admission to the hospital. In multivariate logistic regression, stillbirths were higher among low birth-weight babies (< 2500grams) (adjusted odds ratio (AOR): 10.70, 95% CI 3.18-35.97) than normal birth-weight babies (2500-<4000). Pregnant women who experienced a prolonged labour for more than 48 hours were 12 times (AOR: 12.15, 95% CI 1.76-84.12) more likely to have stillbirths than pregnant women without a prolonged labour. Pregnant women with obstetric complications were 18.9 times more likely to have stillbirths than pregnant women without obstetric complications. Similarly, pregnant women with at least two pregnancies were more likely to have stillbirths than pregnant women with less than two pregnancies (AOR: 4.39, 95% CI 1.21-15.85). CONCLUSIONS We found a high burden of stillbirths in the study setting. Modifiable risk factors contributed to a higher risk of stillbirths; therefore, tailored interventions such as early identification and management of prolonged labour and obstetric complication at each level of health system could avert preventable stillbirths.
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Kumar M, Vajala R, Bhutia P, Singh A. Factors contributing to late stillbirth among women with pregnancy hypertension in a developing country. Hypertens Pregnancy 2020; 39:236-242. [PMID: 32396487 DOI: 10.1080/10641955.2020.1757699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To investigate the factors associated with late stillbirth among women with hypertensive disorders of pregnancy (HDP). MATERIAL AND METHODS The clinical details of women with HDP having late stillbirth were compared with controls having livebirth. RESULTS Total 208 cases and 288 controls were included in the study. Inadequate antenatal visits (p < 0.001, OR-5.92). birth weight < 2000 gms (p < 0.001, OR 10.3) and BW/PW ratio > 8 contributed significantly (p = 0.0001, OR-5.6) to stillbirth. CONCLUSION Poor antenatal care, birth weight below 2000gms and high BW/PW ratio was associated with a higher risk of stillbirth.
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Affiliation(s)
- Manisha Kumar
- Department of Obstetrics and Gynecology, Lady Hardinge Medical College , New Delhi, India
| | - Ravi Vajala
- Department of Statistics, Lady Sri Ram College , New Delhi, India
| | - PhunstokDoma Bhutia
- Department of Obstetrics and Gynecology, Lady Hardinge Medical College , New Delhi, India
| | - Abha Singh
- Department of Obstetrics and Gynecology, Lady Hardinge Medical College , New Delhi, India
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Zile I, Ebela I, Rumba-Rozenfelde I. Maternal Risk Factors for Stillbirth: A Registry-Based Study. MEDICINA (KAUNAS, LITHUANIA) 2019; 55:E326. [PMID: 31266254 PMCID: PMC6681231 DOI: 10.3390/medicina55070326] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 06/26/2019] [Accepted: 06/28/2019] [Indexed: 11/16/2022]
Abstract
Background and Objectives: The number of stillbirths has reduced more slowly than has maternal mortality or mortality in children younger than 5 years, which were explicitly targeted in the Millennium Development Goals. Placental pathologies and infection associated with preterm birth are linked to a substantial proportion of stillbirths. Appropriate preconception care and quality antenatal care that is accessible to all women has the potential to reduce stillbirth rates. The aim of the present study was to assess potential risk factors associated with stillbirth within maternal medical diseases and obstetric complications. Materials and Methods: Retrospective cohort study (2001-2014) was used to analyse data from the Medical Birth Register on stillbirth and live births as controls. Adjusted Odds ratios (aOR) with 95% confidence intervals (CI) were estimated. Multiple regression model adjusted for maternal age, parity and gestational age. Results: The stillbirth rate was 6.2 per 1000 live and stillbirths. The presence of maternal medical diseases greatly increased the risk of stillbirth including diabetes mellitus (aOR = 2.5; p < 0.001), chronic hypertension 3.1 (aOR = 3.1; p < 0.001) and oligohydromnios/polyhydromnios (aOR = 2.4; p < 0.001). Pregnancy complications such as intrauterine growth restriction (aOR = 2.2; p < 0.001) was important risk factor for stillbirth. Abruption was associated with a 2.8 odds of stillbirth. Conclusions: Risk factors most significantly associated with stillbirth include maternal history of chronic hypertension and abruptio placenta which is a common cause of death in stillbirth. Early identification of potential risk factors and appropriate perinatal management are important issues in the prevention of adverse fetal outcomes and preventive strategies need to focus on improving antenatal detection of fetal growth restriction.
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Affiliation(s)
- Irisa Zile
- Faculty of Medicine, Department of Paediatrica, University of Latvia, Raiņa bulvāris 19, Riga, LV-1050, Latvia.
- The Centre for Disease Prevention and Control of Latvia, Duntes 22, k-5, Riga, LV-1005, Latvia.
| | - Inguna Ebela
- Faculty of Medicine, Department of Paediatrica, University of Latvia, Raiņa bulvāris 19, Riga, LV-1050, Latvia
| | - Ingrida Rumba-Rozenfelde
- Faculty of Medicine, Department of Paediatrica, University of Latvia, Raiņa bulvāris 19, Riga, LV-1050, Latvia
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Vestergaard C, Wollenberg A, Barbarot S, Christen-Zaech S, Deleuran M, Spuls P, Flohr C, Trzeciak M, von Kobyletzki L, Seneschal J, Paul C, Bieber T, Werfel T, Fölster-Holst R, Darsow U, Gieler U, Svensson Å, Cork M, Stalder JF, De Raeve L, Kunz B, Simon D, Chernyshov P, Hijnen D, Gelmetti C, Ring J, Taieb A, de Bruin-Weller M, Thyssen JP. European task force on atopic dermatitis position paper: treatment of parental atopic dermatitis during preconception, pregnancy and lactation period. J Eur Acad Dermatol Venereol 2019; 33:1644-1659. [PMID: 31231864 DOI: 10.1111/jdv.15709] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 05/07/2019] [Indexed: 12/14/2022]
Abstract
Atopic dermatitis (AD) is a common inflammatory skin disease that affects both children and adults, including a large number of adults of reproductive age. Several guidelines for the treatment of AD exist, yet specific recommendations for the treatment of pregnant or lactating women and for adults planning to have a child are often lacking. This position paper from the European Task force on Atopic Dermatitis (ETFAD) is based on up-to-date scientific literature on treating pregnant and lactating women as wells as adults with AD planning to have a child. It is based on the expert opinions of members of the ETFAD and on existing safety data on the proposed treatments, many of which are derived from patients with other inflammatory diseases or from transplantation medicine. For treating future parents, as well as pregnant and lactating women with AD, the use of topical treatments including moisturizers, topical corticosteroids, tacrolimus, antiseptics such as chlorhexidine, octenidine, potassium permanganate and sodium hypochlorite (bleach) is deemed to be safe. Ultraviolet (UV) therapy may also be used. Systemic treatment should be prescribed only after careful consideration. According to the opinion of the ETFAD, treatment should be restricted to systemic corticosteroids and cyclosporine A, and, in selected cases, azathioprine.
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Affiliation(s)
- C Vestergaard
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - A Wollenberg
- Department of Dermatology and Allergy, Ludwig-Maximilian University, Munich, Germany.,Hautklinik Thalkirchner Straße, Staedtisches Klinikum Muenchen, Muenchen, Germany
| | - S Barbarot
- Department of Dermatology, CHU Nantes, Nantes, France
| | - S Christen-Zaech
- Pediatric Dermatology Unit, Departments of Dermatology and Pediatrics, Lausanne University Hospital, Lausanne, Switzerland
| | - M Deleuran
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - P Spuls
- Department of Dermatology, Amsterdam Public Health, Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - C Flohr
- St. Johns Institute of Dermatology, Kings College and Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - M Trzeciak
- Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, Gdansk, Poland
| | | | - J Seneschal
- Department of dermatology, INSERM, University of Bordeaux, Bordeaux, France
| | - C Paul
- Department of Dermatology, Larrey Hospital, Toulouse University, Toulouse, France
| | - T Bieber
- Department of Dermatology and Allergology, and Christine Kühne-Center for Allergy Research and Education, University of Bonn, Bonn, Germany
| | - T Werfel
- Department of Dermatology and Allergology, Hannover Medical School, Hannover, Germany
| | - R Fölster-Holst
- Department of Dermatology, Venerology and Allergology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - U Darsow
- Department of Dermatology and Allergology Biederstein, Technical University of Munich, Munich, Germany
| | - U Gieler
- Department of Dermatology, Justus-Liebig-University, Giessen, Germany
| | - Å Svensson
- Department of Dermatology, Lund University, Malmoe, Sweden
| | - M Cork
- Sheffield Dermatology Research, Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - J-F Stalder
- Department of Dermatology, CHU Nantes, Nantes, France
| | - L De Raeve
- Department of Dermatology, UZ Brussel, Free University of Brussels (VUB), Brussels, Belgium
| | - B Kunz
- Dermatologikum, Hamburg, Germany
| | - D Simon
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - P Chernyshov
- Department of Dermatology, National Medical University, Kiev, Ukraine
| | - D Hijnen
- Department of Dermatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - C Gelmetti
- Department of Pediatric Dermatology, Ospedale Maggiore Policlinico, University of Milan, Milano, Italy
| | - J Ring
- Department of Dermatology and Allergology Biederstein, Technical University of Munich, Munich, Germany.,Christiane-Kühne Center for Allergy Research and Education (CK-Care), Davos, Switzerland
| | - A Taieb
- Department of dermatology, INSERM, University of Bordeaux, Bordeaux, France
| | - M de Bruin-Weller
- Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J P Thyssen
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
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Sunjaya AF, Sunjaya AP. Comparing outcomes of nutrition therapy, insulin and oral anti-diabetics in managing diabetes mellitus in Pregnancy: Retrospective study and review of current guidelines. Diabetes Metab Syndr 2019; 13:104-109. [PMID: 30641679 DOI: 10.1016/j.dsx.2018.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 08/21/2018] [Indexed: 11/21/2022]
Abstract
AIMS This study aims to evaluate the glycemic profile and outcomes of Indonesian diabetic pregnant mothers based on their methods of therapy and review current international as well as national guidelines on management of diabetes in pregnancy. MATERIALS AND METHODS Data was obtained from medical records of Hermina-Podomoro Hospital. Subjects were grouped based on therapy - nutrition therapy only, insulin and oral anti-diabetics group. RESULTS Forty-five subjects were obtained with an average age of 31-years. Around thirty-five percent of patients were given nutrition therapy only, 55.6% were using insulin and 8.8% were using oral anti-diabetics. Oral anti-diabetics users showed worse glycemic profile among the three groups. Six-patients suffered from IUFD with the highest proportion found in oral anti-diabetics users. CONCLUSION The above results show the negative impacts of DM on pregnant mothers and the unborn. Caution is advised on the use of oral anti-diabetics as it may increase the risk of infant mortality. Increased monitoring and prenatal services for DM patients are essential in achieving blood glucose targets.
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Affiliation(s)
- Angela F Sunjaya
- Faculty of Medicine, Tarumanagara University Jl. Letjen S. Parman No.1, Jakarta, Indonesia
| | - Anthony P Sunjaya
- Faculty of Medicine, Tarumanagara University Jl. Letjen S. Parman No.1, Jakarta, Indonesia.
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Lu HW, Wang FY, Chang CK, Teng SW, Wang PH. Postpartum flare up of systemic lupus erythematosus: Pulmonary diffused alveolar hemorrhage. Taiwan J Obstet Gynecol 2018; 57:906-907. [DOI: 10.1016/j.tjog.2018.10.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2018] [Indexed: 11/27/2022] Open
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Wang CK, Lin CK, Wang TJ, Wang CY, Hsu PC, Su HY. Pregnancy and childbirth in a patient with multiple sclerosis: A case report of successful management. Taiwan J Obstet Gynecol 2018; 57:447-448. [PMID: 29880182 DOI: 10.1016/j.tjog.2018.04.021] [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: 10/30/2017] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Multiple sclerosis (MS) preferentially affects females of reproductive age, making reproduction an important issue for women with MS. An increased incidence of poor labor progress often results in assisted vaginal delivery or a cesarean section. However, with good pre-pregnancy counseling and management, women with MS can conceive and give birth safely. Here, we present a case of pregnancy with MS, which was carried to term uneventfully and ended with unassisted vaginal delivery. CASE REPORT A 36-year-old woman was treated for MS for three years before she conceived. Because of her mild clinical presentation, medication was discontinued when her pregnancy was confirmed. Counseling was completed, and she had a smooth pregnancy course and gave birth vaginally at 38 weeks and two days. CONCLUSION Based on this case report, women with mild clinical presentation of MS before pregnancy can conceive and carry successfully to term with no or improved disease presentation.
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Affiliation(s)
- Chun-Kai Wang
- Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chi-Kang Lin
- Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Tun-Jun Wang
- Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chen-Yu Wang
- Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Po-Chao Hsu
- Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Her-Young Su
- Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
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A Comprehensive Update on Stillbirth Prevention: from Preconception to Postpartum, Individuals to Public Health Administrations. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2018. [DOI: 10.1007/s13669-018-0251-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Khader YS, Batieha A, Khader A, Hamadneh S. Stillbirths in Jordan: rate, causes, and preventability. J Matern Fetal Neonatal Med 2018; 33:1307-1314. [PMID: 30153760 DOI: 10.1080/14767058.2018.1517326] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Objectives: This study aimed to determine the stillbirth rate in Jordan and to determine the leading causes of stillbirths. Analyzing the stillbirth data from a large sample size of Jordanian women would be very valuable for planning the resources and improving the services.Methods: The data from the national study of perinatal mortality in Jordan were analyzed. A total of 21,980 women who delivered at a gestational age ≥20 weeks in any of the 18 selected hospitals during the study period (March 2011-April 2012) were analyzed. The stillbirth rate was calculated as the number of stillbirths per 1000 total births. The deaths were also classified according to NICE classification system.Results: The rates of stillbirths were 11.6/1000 total births born after 20 weeks of gestation, 11.2/1000 total births born ≥22 weeks of gestation, 10.6/1000 total births born ≥24 weeks of gestation, and 9.0/1000 total births born ≥28 weeks of gestation. According to NICE classification, the main causes of stillbirths were maternal diseases (19.5%), unexplained immaturity (18.8%), congenital anomalies (17.6%), unexplained antepartum stillbirths (17.6%), obstetric complications (8.4%), placental abruption (5.7%), and multiple births (5%). The expert Panel judged that 34.5% of all fetal deaths were preventable and 30.3% were possibly preventable with optimal care.Conclusions: This study highlighted stillbirth risks in Jordan, which could encourage maternal-infant health-care providers, other researchers, policymakers, and stakeholders to implement solutions and to develop a feasible intervention.
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Affiliation(s)
- Yousef S Khader
- Faculty of Medicine, Department of Community Medicine, Public Health and Family Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Anwar Batieha
- Faculty of Medicine, Department of Community Medicine, Public Health and Family Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Albaraa Khader
- Faculty of Medicine, Department of Community Medicine, Public Health and Family Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Shereen Hamadneh
- Faculty of Nursing, Department of Maternal and Child Health, Al Albayt University, Mafraq, Jordan
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Singh A, Kumar M. An Analysis of Cause of Stillbirth in a Tertiary Care Hospital of Delhi: A Contribution to the WHO SEARO Project. J Obstet Gynaecol India 2018; 69:155-160. [PMID: 30956470 DOI: 10.1007/s13224-018-1161-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 07/19/2018] [Indexed: 11/25/2022] Open
Abstract
Background Over 98% of the world's total stillbirths are believed to occur in developing countries and still have received very little research, programmatic or policy attention. Aims and Objective To collect data on epidemiological profile of cases experiencing stillbirths, to assess the associated antenatal high risk factors present and to find out the probable cause of stillbirth. Materials and Methods This was a cross-sectional, observational study, which was done as part of WHO SEARO project after ethical clearance. The study included all stillbirths which occurred in the hospital during the study period August 2015-February 2017. Antenatal records were reviewed; maternal investigations were done. Baby was examined after delivery. Pre-structured pro forma was filled for every case. Finally, the relevant condition found was classified under CODAC system of stillbirth classification. Result Out of 20,580 deliveries, 600 (2.9%) were stillborn. Maternal cause was noted in 145/600 (24.2%) cases, fetal cause was noted in 181/600 (30.2%), and placental and cord origins were suspected in 128/600 (21.3%) and 12/600 (2%) cases, respectively. In 72/600 (12.0%) cases the reason for stillbirth was unknown and unclassifiable. Among the maternal causes the most common was hypertension (89/600, 14.8%) followed by infection including fever (5.7%); the most common infection was hepatitis. Among the fetal causes birth defect was the most common (106/600, 17.7%) followed by extreme prematurity in 42/600 (7.0%). Conclusion Birth defects were the most important fetal cause of stillbirth; hypertension in pregnancy and fetal growth restriction were important associated factors.
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Affiliation(s)
- Abha Singh
- Department of Obstetrics and Gynecology, Lady Hardinge Medical College, Shahid Bhagat Singh Marg, New Delhi, 110001 India
| | - Manisha Kumar
- Department of Obstetrics and Gynecology, Lady Hardinge Medical College, Shahid Bhagat Singh Marg, New Delhi, 110001 India
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31
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Reed LC, Estrada SM, Walton RB, Napolitano PG, Ieronimakis N. Evaluating maternal hyperglycemic exposure and fetal placental arterial dysfunction in a dual cotyledon, dual perfusion model. Placenta 2018; 69:109-116. [PMID: 30213479 DOI: 10.1016/j.placenta.2018.07.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 07/11/2018] [Accepted: 07/27/2018] [Indexed: 01/17/2023]
Abstract
BACKGROUND Gestational diabetes affects almost 1 in 10 pregnancies and is associated with adverse outcomes including fetal demise. Pregnancy complications related to diabetes are attributed to placental vascular dysfunction. With diabetes, maternal hyperglycemia is thought to promote placental vasoconstriction. However, it remains poorly understood if and how hyperglycemia leads to placental vascular dysfunction or if humoral factors related to maternal diabetes are responsible. METHODS AND RESULTS Utilizing a human placenta dual cotyledon, dual perfusion assay we examined the arterial pressure response to the thromboxane mimetic U44619, in cotyledons exposed to normal vs. a hyperglycemic infusion into the intervillous space. Tissues were then analyzed for the activity of key signaling molecules related to vascular tone; eNOS, Akt, PKA and VEGFR2. Results indicate a significant increase in fetal vascular resistance with maternal exposure to hyperglycemia. This response corresponded with a reduction in the phosphorylation of eNOS at Ser1177 and Akt at Thr308. In contrast, VEGFR2 at Tyr1175 and PKA at Thr197 were not different with hyperglycemia. CONCLUSION Reductions of eNOS and Akt phosphorylation at key residues implicated in nitric oxide production suggest that hyperglycemia alters the vasodilatory signaling of placental vessels. In contrast, acute hyperglycemic exposure may not alter vasoconstriction via VEGF and PKA signaling. Altogether our results link hyperglycemic exposure in human placentas to nitric oxide signaling; a mechanisms that may account for the elevations in vascular resistance commonly observed in diabetic pregnancies.
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Affiliation(s)
- Luckey C Reed
- Department of Obstetrics and Gynecology, Madigan Army Medical Center, Tacoma, WA, USA
| | - Sarah M Estrada
- Department of Obstetrics and Gynecology, Madigan Army Medical Center, Tacoma, WA, USA
| | - Robert B Walton
- Department of Obstetrics and Gynecology, Madigan Army Medical Center, Tacoma, WA, USA
| | - Peter G Napolitano
- Department of Obstetrics and Gynecology, Madigan Army Medical Center, Tacoma, WA, USA
| | - Nicholas Ieronimakis
- Department of Clinical Investigation, Madigan Army Medical Center, Tacoma, WA, USA.
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Rotem R, Pariente G, Golevski M, Baumfeld Y, Yohay D, Weintraub AY. Association between hypertensive disorders of pregnancy and third stage of labor placental complications. Pregnancy Hypertens 2018; 13:166-170. [DOI: 10.1016/j.preghy.2018.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 03/20/2018] [Accepted: 06/09/2018] [Indexed: 01/31/2023]
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Newtonraj A, Kaur M, Gupta M, Kumar R. Level, causes, and risk factors of stillbirth: a population-based case control study from Chandigarh, India. BMC Pregnancy Childbirth 2017; 17:371. [PMID: 29132325 PMCID: PMC5684767 DOI: 10.1186/s12884-017-1557-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 11/02/2017] [Indexed: 12/13/2022] Open
Abstract
Background Globally, India ranks first in the absolute number of stillbirths. Hence, the level, causes, and risk factors of stillbirths were estimated to facilitate designing of prevention strategy. Methods Capture and recapture method was used to identify 301 stillbirths from 1st July 2013 to 31st August 2014 in Chandigarh Union Territory of India. Verbal autopsies (n = 181) were done at household level to identify causes of stillbirths. Risk factors were determined using case-control approach. Women who had a stillbirth in the past 3 months were enrolled as cases (n = 181) and those who had live-birth in same neighbourhood were included as controls (n = 181). Statistical differences in the distribution of characteristics of cases and controls were tested by t test and chi square test respectively for quantitative and categorical variables. In logistic regression models adjusted odds ratios (aOR) and 95% confidence intervals (CIs) were estimated for various risk factors. Results Stillbirth rate was estimated to be 16/1000 birth. Antepartum causes were more common (68%) than intrapartum causes (32%). Among maternal conditions, hypertension (18.2%) and chorio-amnionitis (13.8%), and among foetal conditions, growth restriction (19.9%) and congenital anomalies (18.8%) were the leading causes. In about half of the stillbirths foetal (48%) and maternal (44.7%) causes were unidentifiable. Risk factors of stillbirths were: higher maternal age (aOR 1.1, 95%CI 1.0–1.2), vaginal delivery (aOR 8.1, 95%CI 2.6–26), induced labour (aOR 2.6, 95%CI 1.5–4.5), green or light brown liquor (aOR 2.0, 95%CI 1.1–3.8), preterm delivery (aOR 6.4, 95%CI 3.7–11) and smaller household size (aOR 1.2, 95% CI 1.1–1.3). Conclusions Stillbirth rate was high in Chandigarh Union Territory of India. Major causes and risk factors amenable to interventions were infections, hypertension, congenital malformations, foetal growth restriction, pre-maturity and household size. Therefore, better maternity ante-natal and intra-natal care is required to achieve a single digit stillbirth rate. Electronic supplementary material The online version of this article (10.1186/s12884-017-1557-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ariarathinam Newtonraj
- Department of Community Medicine, School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Manmeet Kaur
- Department of Community Medicine, School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, 160 012, India.
| | - Madhu Gupta
- Department of Community Medicine, School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Rajesh Kumar
- Department of Community Medicine, School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, 160 012, India
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Wingate MS, Smith RA, Petrini JR, Barfield WD. Disparities in gestational age-specific fetal mortality rates in the United States, 2009-2013. Ann Epidemiol 2017; 27:570-574. [PMID: 28888835 DOI: 10.1016/j.annepidem.2017.08.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 08/03/2017] [Accepted: 08/11/2017] [Indexed: 11/18/2022]
Abstract
PURPOSE Although studies have examined overall temporal changes in gestational age-specific fetal mortality rates, there is little information on the current status of racial/ethnic differences. We hypothesize that differences exist between racial/ethnic groups across gestational age and that these differences are not equally distributed. METHODS Using the 2009-2013 data from US fetal death and live birth files for non-Hispanic white (NHW); non-Hispanic black (NHB); Hispanic; and American Indian/Alaska Native (AIAN) women, we conducted analyses to examine fetal mortality rates and estimate adjusted prevalence rate ratios and 95% confidence intervals (CIs). RESULTS There were lower risks of fetal mortality among NHB women (aPRR = 0.76; 95% CI = 0.71-0.81) and Hispanic women (aPRR = 0.89; 95% CI = 0.83-0.96) compared with NHWs at 22-23 weeks' gestation. For NHB women, the risk was higher starting at 32-33 weeks (aPRR = 1.11; 95% CI = 1.04-1.18) and continued to increase as gestational age increased. Hispanic and AIAN women had lower risks of fetal mortality compared with NHW women until 38-39 weeks. CONCLUSIONS Further examination is needed to identify causes of fetal death within the later pregnancy period and how those causes and their antecedents might differ by race and ethnicity.
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Affiliation(s)
- Martha S Wingate
- Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, Alabama.
| | - Ruben A Smith
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Joann R Petrini
- Department of Research and Innovation, Western Connecticut Health Network, Danbury, CT
| | - Wanda D Barfield
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
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Tavares Da Silva F, Gonik B, McMillan M, Keech C, Dellicour S, Bhange S, Tila M, Harper DM, Woods C, Kawai AT, Kochhar S, Munoz FM. Stillbirth: Case definition and guidelines for data collection, analysis, and presentation of maternal immunization safety data. Vaccine 2016; 34:6057-6068. [PMID: 27431422 PMCID: PMC5139804 DOI: 10.1016/j.vaccine.2016.03.044] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 03/15/2016] [Indexed: 12/18/2022]
Affiliation(s)
| | - Bernard Gonik
- Wayne State University School of Medicine, Detroit, MI, USA
| | - Mark McMillan
- The University of Adelaide, North Adelaide, South Australia, Australia
| | | | | | | | | | - Diana M Harper
- University of Louisville School of Medicine, Louisville, KY, USA
| | - Charles Woods
- University of Louisville School of Medicine, Louisville, KY, USA
| | - Alison Tse Kawai
- Harvard Medical School and Harvard Pilgrim Health Care Institute, MA, USA
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Abstract
Stillbirths are among the most common pregnancy-related adverse outcomes but are more common in low-income and middle-income countries than in high-income countries. In high-income countries, most stillbirths occur early in the preterm period, whereas in low-income and middle-income countries, most occur in term or in late preterm births. In low-income and middle-income countries, conditions, such as prolonged or obstructed labor, placental abruption, preeclampsia/eclampsia, fetal growth restriction, fetal distress, breech and other abnormal presentations, and multiple births, are associated with stillbirth. In high-income countries, placental abnormalities are the most common associations. Globally, fetal asphyxia is likely the most common final pathway to stillbirth.
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Wang L, Kuromaki K, Kawabe A, Kikugawa A, Matsunaga S, Takagi A. Nuchal cord complication in male small for gestational age increases fetal distress risk during labor. Taiwan J Obstet Gynecol 2016; 55:568-74. [DOI: 10.1016/j.tjog.2016.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2016] [Indexed: 01/13/2023] Open
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Lavezzi AM, Ferrero S, Matturri L, Roncati L, Pusiol T. Developmental neuropathology of brainstem respiratory centers in unexplained stillbirth: What's the meaning? Int J Dev Neurosci 2016; 53:99-106. [DOI: 10.1016/j.ijdevneu.2016.06.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 06/24/2016] [Accepted: 06/24/2016] [Indexed: 01/28/2023] Open
Affiliation(s)
- Anna M. Lavezzi
- “Lino Rossi” Research Center for the Study and Prevention of Unexpected Perinatal Death and SIDSDepartment of Biomedical, Surgical and Dental SciencesUniversity of MilanItaly
| | - Stefano Ferrero
- “Lino Rossi” Research Center for the Study and Prevention of Unexpected Perinatal Death and SIDSDepartment of Biomedical, Surgical and Dental SciencesUniversity of MilanItaly
- Division of Pathology, Fondazione IRCCS Ca' GrandaOspedale Maggiore PoliclinicoMilanItaly
- Department of Biomedical, Surgical and Dental SciencesUniversity of MilanMilanItaly
| | - Luigi Matturri
- “Lino Rossi” Research Center for the Study and Prevention of Unexpected Perinatal Death and SIDSDepartment of Biomedical, Surgical and Dental SciencesUniversity of MilanItaly
| | - Luca Roncati
- Institute of PathologyHospital of Rovereto (Trento)Italy
- Department of Diagnostic and Clinical Medicine and of Public Health, Section of PathologyUniversity of Modena and Reggio EmiliaPoliclinico HospitalModenaItaly
| | - Teresa Pusiol
- Institute of PathologyHospital of Rovereto (Trento)Italy
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Aldrighi JD, Wall ML, Souza SRRK, Cancela FZV. The experiences of pregnant women at an advanced maternal age: an integrative review. Rev Esc Enferm USP 2016; 50:512-21. [DOI: 10.1590/s0080-623420160000400019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract OBJECTIVE To identify in the literature how the experiences of women age 35 or above are described in terms of pregnancy. METHOD Integrative review based on MEDLINE/PubMed, CINAHL, LILACS, and SciELO databases, with no time period constraint. RESULTS Eighteen studies that dealt with the experiences of pregnant women at an advanced maternal age were selected and analyzed. The studies evidenced four theme categories: the search for information, which pointed to a deficit of information supplied by health care professionals; perceiving the risks, which pointed to women's concerns about their own health and their children's; the ideal moment for motherhood, with different reasons for postponing it; and adjusting to a new routine, showing a concern regarding changes in daily life. CONCLUSION From the results, it was possible to understand that other factors, in addition to those that include risks, are present in the experiences of older pregnant women and point to a need to involve such aspects in nursing care to create comprehensive strategies that are aligned with these women's needs.
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