1
|
Pollock D, Bailey HD, Hasanoff S, Munn Z, Valenzuela C, Stern C, Price C, Marriott R, Gliddon J, Lewis C, Michie C, Bowie M, Penny M, Reibel T, Warland J, Farrant B, White SW, Shepherd CCJ. First Nations Peoples' perceptions, knowledge and beliefs regarding stillbirth prevention and bereavement practices: A mixed methods systematic review. Women Birth 2024; 37:101604. [PMID: 38640744 DOI: 10.1016/j.wombi.2024.101604] [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: 12/05/2023] [Revised: 03/24/2024] [Accepted: 03/25/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND First Nations Peoples endure disproportionate rates of stillbirth compared with non-First Nations Peoples. Previous interventions have aimed at reducing stillbirth in First Nations Peoples and providing better bereavement care without necessarily understanding the perceptions, knowledge and beliefs that could influence the design of the intervention and implementation. AIM The aim of this review was to understand the perceptions, knowledge and beliefs about stillbirth prevention and bereavement of First Nations Peoples from the US, Canada, Aotearoa/New Zealand, and Australia. METHODS This review was conducted in accordance with the JBI methodology for a convergent integrated mixed method systematic review. This review was overseen by an advisory board of Aboriginal Elders, researchers, and clinicians. A search of eight databases (PubMed, MEDLINE, PsycInfo, CINAHL, Embase, Emcare, Dissertations and Theses and Indigenous Health InfoNet) and grey literature was conducted. All studies were screened, extracted, and appraised for quality by two reviewers and results were categorised, and narratively summarised. RESULTS Ten studies were included within this review. Their findings were summarised into four categories: safeguarding baby, traditional practices of birthing and grieving, bereavement photography and post-mortem examination. The results indicate a diversity of perceptions, knowledge and beliefs primarily around smoking cessation and bereavement practices after stillbirth. However, there was a paucity of research available. CONCLUSIONS Further research is needed to understand the perceptions, knowledge and beliefs about stillbirth among First Nations Peoples. Without research within this area, interventions to prevent stillbirth and support bereaved parents and their communities after stillbirth may face barriers to implementation.
Collapse
Affiliation(s)
- Danielle Pollock
- Health Evidence Synthesis Recommendations and Impact (HESRI), School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia.
| | - Helen D Bailey
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Perth, WA, Australia; Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Sabira Hasanoff
- Health Evidence Synthesis Recommendations and Impact (HESRI), School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Zachary Munn
- Health Evidence Synthesis Recommendations and Impact (HESRI), School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Chelsea Valenzuela
- JBI, School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Cindy Stern
- JBI, School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Carrie Price
- Albert S. Cook Library, Towson University, Towson, MD, USA
| | - Rhonda Marriott
- Ngangk Yira Institute for Change, Murdoch University, Perth, WA, Australia
| | - Janinne Gliddon
- Ngangk Yira Institute for Change, Murdoch University, Perth, WA, Australia
| | - Carolyn Lewis
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Carol Michie
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Muriel Bowie
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Millie Penny
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Tracy Reibel
- Ngangk Yira Institute for Change, Murdoch University, Perth, WA, Australia
| | | | - Brad Farrant
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Scott W White
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, WA, Australia; Maternal Fetal Medicine Service, King Edward Memorial Hospital, Perth, WA, Australia; The Western Australian Centre for Health Research for Women and Babies, The University of Western Australia, Perth, WA, Australia
| | - Carrington C J Shepherd
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Perth, WA, Australia; Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia; Ngangk Yira Institute for Change, Murdoch University, Perth, WA, Australia
| |
Collapse
|
2
|
Sharma K, Bhat S, Bhat SM. Causes of stillbirth in ethnically diverse women in a Perth metropolitan hospital: A retrospective study. Aust N Z J Obstet Gynaecol 2024; 64:141-146. [PMID: 37905931 DOI: 10.1111/ajo.13761] [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: 04/02/2023] [Accepted: 10/05/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND Most published reports analysing the differences in causation of stillbirth between different ethnic groups focus on stillbirth risk factors, with a paucity of data comparing actual causes of stillbirth. AIMS To determine whether causes of stillbirth differ between Caucasian and non-Caucasian ethnic groups in an Australian context. MATERIALS AND METHODS Data from all stillbirths occurring at 20 or more completed weeks of gestation between 1 January 2010 and 31 December 2020 at a secondary level, outer metropolitan hospital, were analysed in this retrospective case series. Causes of stillbirth as determined by perinatal autopsy and placental histopathology were categorised using the Perinatal Society of Australia and New Zealand Perinatal Death Classification and compared between Caucasian and non-Caucasian groups. RESULTS Ninety-two stillbirths (0.7% of all births) were identified during the study period. A greater proportion of non-Caucasian women had small for gestation age placentas compared to Caucasian women (n = 22/43 (51%) vs n = 12/49 (24%); P = 0.025). A greater proportion of stillbirths were caused by hypoxic peripartum death in non-Caucasian than in Caucasian women (n = 4/43 (9%) vs n = 0/49 (0%); P = 0.044), and a greater prevalence of placental dysfunction was seen in the non-Caucasian cohort compared to Caucasian women (n = 14/43 (33%) vs n = 8/49 (16%); P = 0.057). CONCLUSIONS The differences observed in causes of stillbirth between Caucasian and non-Caucasian women are hypothesis generating and warrant further larger-scale, multi-centred studies using standardised definitions and classification systems to determine whether these differences persist in a more representative sample.
Collapse
Affiliation(s)
- Kriti Sharma
- Royal Perth Hospital, Perth, Western Australia, Australia
| | - Saiuj Bhat
- Department of Vascular Surgery, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Sangeeta Malla Bhat
- Department of Obstetrics and Gynaecology, Armadale Health Service, Perth, Western Australia, Australia
| |
Collapse
|
3
|
Bakhbakhi D, Siassakos D, Davies A, Merriel A, Barnard K, Stead E, Shakespeare C, Duffy JMN, Hinton L, McDowell K, Lyons A, Fraser A, Burden C. Interventions, outcomes and outcome measurement instruments in stillbirth care research: A systematic review to inform the development of a core outcome set. BJOG 2023; 130:560-576. [PMID: 36655361 DOI: 10.1111/1471-0528.17390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 10/08/2022] [Accepted: 10/26/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND A core outcome set could address inconsistent outcome reporting and improve evidence for stillbirth care research, which have been identified as an important research priority. OBJECTIVES To identify outcomes and outcome measurement instruments reported by studies evaluating interventions after the diagnosis of a stillbirth. SEARCH STRATEGY Amed, BNI, CINAHL, ClinicalTrials.gov, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Embase, MEDLINE, PsycINFO, and WHO ICTRP from 1998 to August 2021. SELECTION CRITERIA Randomised and non-randomised comparative or non-comparative studies reporting a stillbirth care intervention. DATA COLLECTION AND ANALYSIS Interventions, outcomes reported, definitions and outcome measurement tools were extracted. MAIN RESULTS Forty randomised and 200 non-randomised studies were included. Fifty-eight different interventions were reported, labour and birth care (52 studies), hospital bereavement care (28 studies), clinical investigations (116 studies), care in a multiple pregnancy (2 studies), psychosocial support (28 studies) and care in a subsequent pregnancy (14 studies). A total of 391 unique outcomes were reported and organised into 14 outcome domains: labour and birth; postpartum; delivery of care; investigations; multiple pregnancy; mental health; emotional functioning; grief and bereavement; social functioning; relationship; whole person; subsequent pregnancy; subsequent children and siblings and economic. A total of 242 outcome measurement instruments were used, with 0-22 tools per outcome. CONCLUSIONS Heterogeneity in outcome reporting, outcome definition and measurement tools in care after stillbirth exists. Considerable research gaps on specific intervention types in stillbirth care were identified. A core outcome set is needed to standardise outcome collection and reporting for stillbirth care research.
Collapse
Affiliation(s)
| | | | - Anna Davies
- Centre for Academic Child Health, University of Bristol, Bristol, UK
| | | | | | - Emma Stead
- Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | | | | | - Lisa Hinton
- THIS Institute, University of Cambridge, Cambridge, UK
| | | | - Anna Lyons
- Northern General Hospital, Sheffield, UK
| | | | | |
Collapse
|
4
|
Gupta N, Martinez-Rios C, El Demellawy D, Barrowman N, Miller E. Diagnostic Evaluation of the Posterior Fossa with Antenatal and Post-Mortem MRI: An Unfolded View. JOURNAL OF FETAL MEDICINE 2022. [DOI: 10.1007/s40556-021-00329-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
5
|
Bhat S, Birdus N, Bhat SM. Ethnic variation in causes of stillbirth in high income countries: A systematic review and meta-analysis. Int J Gynaecol Obstet 2021; 158:270-277. [PMID: 34767262 DOI: 10.1002/ijgo.14023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/08/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Inequities in stillbirth rate according to ethnicity persist in high income nations. The objective of the present study is to investigate whether causes of stillbirth differ by ethnicity in high-income nations. METHODS The following databases were searched since their inception to 1 February 2021: Medline, Embase, Scopus, CINAHL, Cochrane Library, and Global Health. Cohort, cross-sectional, and retrospective studies were included. Causes of stillbirth were aligned to the International Classification of Disease 10 for Perinatal Mortality (ICD10-PM) and pooled estimates were derived by meta-analysis. RESULTS Fifteen reports from three countries (72 555 stillbirths) were included. Seven ethnic groups - "Caucasian" (n = 11 studies), "African" (n = 11 studies), "Hispanic" (n = 7 studies), "Indigenous Australian" (n = 4 studies), "Asian" (n = 2 studies), "South Asian" (n = 2 studies), and "American Indian" (n = 1 study) - were identified. There was an overall paucity of recent, high-quality data for many ethnicities. For those with the greatest amount of data - Caucasian, African, and Hispanic - no major differences in the causes of stillbirth were identified. CONCLUSION There is a paucity of high-quality information on causes of stillbirth for many ethnicities. Improving investigation and standardizing classification of stillbirths is needed to assess whether causes of stillbirth differ across more diverse ethnic groups.
Collapse
Affiliation(s)
- Saiuj Bhat
- Royal Perth Hospital, Perth, Western Australia, Australia
| | - Nadya Birdus
- Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | | |
Collapse
|
6
|
Cronin RS, Thompson JMD, Taylor RS, Wilson J, Falloon KF, Skelton S, Brown E, Culling VM, Mitchell EA, McCowan LME. Modification of maternal late pregnancy sleep position: a survey evaluation of a New Zealand public health campaign. BMJ Open 2021; 11:e047681. [PMID: 33980531 PMCID: PMC8118030 DOI: 10.1136/bmjopen-2020-047681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 04/16/2021] [Accepted: 04/20/2021] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION A 'Sleep-On-Side When Baby's Inside' public health campaign was initiated in New Zealand in 2018. This was in response to evidence that maternal supine going-to-sleep position was an independent risk factor for stillbirth from 28 weeks' gestation. We evaluated the success of the campaign on awareness and modification of late pregnancy going-to-sleep position through nationwide surveys. METHODS AND ANALYSIS Two web-based cross-sectional surveys were conducted over 12 weeks in 2019-2020 in a sample of (1) pregnant women ≥28 weeks, primary outcome of going-to-sleep position; and (2) health professionals providing pregnancy care, primary outcome of knowledge of going-to-sleep position and late stillbirth risk. Univariable logistic regression was performed to identify factors associated with supine going-to-sleep position. DISCUSSION The survey of pregnant women comprised 1633 eligible participants. Going-to-sleep position last night was supine (30, 1.8%), non-supine (1597, 97.2%) and no recall (16, 1.0%). Supine position had decreased from 3.9% in our previous New Zealand-wide study (2012-2015). Most women (1412, 86.5%) had received sleep-on-side advice with no major resultant worry (1276, 90.4%). Two-thirds (918, 65.0%) had changed their going-to-sleep position based on advice, with most (611 of 918, 66.5%) reporting little difficulty. Supine position was associated with Māori (OR 5.05, 95% CI 2.10 to 12.1) and Asian-non-Indian (OR 4.20, 95% CI 1.27 to 13.90) ethnicity; single (OR 10.98, 95% CI 4.25 to 28.42) and cohabitating relationship status (OR 2.69, 95% CI 1.09 to 6.61); hospital-based maternity provider (OR 2.55, 95% CI 1.07 to 6.10); education overseas (OR 3.92, 95% CI 1.09 to 14.09) and primary-secondary level (OR 2.80, 95% CI 1.32 to 6.08); and not receiving sleep-on-side advice (OR 6.70, 95% CI 3.23 to 13.92). The majority of health professionals (709 eligible participants) reported awareness of supine going-to-sleep position and late stillbirth risk (543, 76.6%). CONCLUSION Most pregnant women had received and implemented sleep-on-side advice without major difficulty or concern. Some groups of women may need a tailored approach to acquisition of going-to-sleep position information.
Collapse
Affiliation(s)
- Robin S Cronin
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
- Division of Women's Health, Counties Manukau District Health Board, Auckland, New Zealand
| | - John M D Thompson
- Paediatrics: Child Health and Youth Health, University of Auckland, Auckland, New Zealand
| | - Rennae S Taylor
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Jessica Wilson
- Paediatrics: Child Health and Youth Health, University of Auckland, Auckland, New Zealand
| | - Karen F Falloon
- General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand
| | - Sophie Skelton
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Elsie Brown
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Vicki M Culling
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
- Vicki Culling Associates, Wellington, New Zealand
| | - Edwin A Mitchell
- Paediatrics: Child Health and Youth Health, University of Auckland, Auckland, New Zealand
| | - Lesley M E McCowan
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| |
Collapse
|
7
|
Chandrasekaran P, Goergen S, Robinson A, Moghimi A, Malhotra A. Bilateral congenital pulmonary airway malformation in an extremely preterm infant. BMJ Case Rep 2021; 14:e242228. [PMID: 33858905 PMCID: PMC8055105 DOI: 10.1136/bcr-2021-242228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2021] [Indexed: 11/03/2022] Open
Abstract
We present the case of a baby boy, with antenatal finding of bilateral enlarged echogenic lungs, who developed severe postnatal respiratory failure. Two important differential diagnoses, which have an impact on antenatal and postnatal management, are discussed. Fetal ultrasound, MRI and postmortem MRI images are presented and findings correlated with the autopsy findings.
Collapse
Affiliation(s)
| | - Stacy Goergen
- Monash Imaging, Monash Health, Clayton, Victoria, Australia
| | - Alice Robinson
- Fetal Diagnostic Unit, Monash Health, Clayton, Victoria, Australia
| | - Ali Moghimi
- Department of Anatomical Pathology, Monash Health, Clayton, Victoria, Australia
| | - Atul Malhotra
- Monash Newborn, Monash Children's Hospital, Clayton, Victoria, Australia
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia
| |
Collapse
|
8
|
Zhang Y, Gargan S, Lu Y, Stevenson NJ. An Overview of Current Knowledge of Deadly CoVs and Their Interface with Innate Immunity. Viruses 2021; 13:560. [PMID: 33810391 PMCID: PMC8066579 DOI: 10.3390/v13040560] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/12/2021] [Accepted: 03/16/2021] [Indexed: 02/06/2023] Open
Abstract
Coronaviruses are a large family of zoonotic RNA viruses, whose infection can lead to mild or lethal respiratory tract disease. Severe Acute Respiratory Syndrome-Coronavirus-1 (SARS-CoV-1) first emerged in Guangdong, China in 2002 and spread to 29 countries, infecting 8089 individuals and causing 774 deaths. In 2012, Middle East Respiratory Syndrome-Coronavirus (MERS-CoV) emerged in Saudi Arabia and has spread to 27 countries, with a mortality rate of ~34%. In 2019, SARS-CoV-2 emerged and has spread to 220 countries, infecting over 100,000,000 people and causing more than 2,000,000 deaths to date. These three human coronaviruses cause diseases of varying severity. Most people develop mild, common cold-like symptoms, while some develop acute respiratory distress syndrome (ARDS). The success of all viruses, including coronaviruses, relies on their evolved abilities to evade and modulate the host anti-viral and pro-inflammatory immune responses. However, we still do not fully understand the transmission, phylogeny, epidemiology, and pathogenesis of MERS-CoV and SARS-CoV-1 and -2. Despite the rapid application of a range of therapies for SARS-CoV-2, such as convalescent plasma, remdesivir, hydroxychloroquine and type I interferon, no fully effective treatment has been determined. Remarkably, COVID-19 vaccine research and development have produced several offerings that are now been administered worldwide. Here, we summarise an up-to-date understanding of epidemiology, immunomodulation and ongoing anti-viral and immunosuppressive treatment strategies. Indeed, understanding the interplay between coronaviruses and the anti-viral immune response is crucial to identifying novel targets for therapeutic intervention, which may even prove invaluable for the control of future emerging coronavirus.
Collapse
Affiliation(s)
- Yamei Zhang
- Viral Immunology Group, School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, D02 R590 Dublin, Ireland; (Y.Z.); (S.G.)
| | - Siobhan Gargan
- Viral Immunology Group, School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, D02 R590 Dublin, Ireland; (Y.Z.); (S.G.)
| | - Yongxu Lu
- Department of Pathology, University of Cambridge, Cambridge CB2 1QP, UK;
| | - Nigel J. Stevenson
- Viral Immunology Group, School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, D02 R590 Dublin, Ireland; (Y.Z.); (S.G.)
- Viral Immunology Group, Royal College of Surgeons in Ireland—Medical University of Bahrain, Adliya 15503, Bahrain
| |
Collapse
|
9
|
Bedwell C, Blaikie K, Actis Danna V, Sutton C, Laisser R, Tembo Kasengele C, Wakasiaka S, Victor S, Lavender T. Understanding the complexities of unexplained stillbirth in sub-Saharan Africa: a mixed-methods study. BJOG 2021; 128:1206-1214. [PMID: 33319470 PMCID: PMC8248405 DOI: 10.1111/1471-0528.16629] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2020] [Indexed: 01/10/2023]
Abstract
Objective To understand the complexities surrounding unexplained stillbirth for the development and implementation of culturally acceptable interventions to underpin care in Tanzania and Zambia. Design Mixed‐methods study. Setting Tertiary, secondary and primary care facilities in Mansa, Zambia, and Mwanza, Tanzania. Sample Quantitative: 1997 women giving birth at two tertiary care facilities (one in each country). Qualitative: 48 women and 19 partners from tertiary, secondary and primary care facilities. Methods Case review using data from a target of 2000 consecutive case records. Qualitative interviews with a purposive sample of women and partners, using a grounded theory approach. Results A total of 261 stillbirths were recorded, with a rate of 16% in Tanzania and 10% in Zambia, which is higher than the previous estimates of 2.24 and 2.09%, respectively, for those countries. Women in both countries who reported a previous stillbirth were more likely to have stillbirth (RR 1.86, 95% CI 1.23–2.81). The cause of death was unexplained in 28% of cases. Qualitative findings indicated that not knowing what caused the baby to be stillborn prevented women from grieving. This was compounded by the poor communication skills of health professionals, who displayed little empathy and skill when counselling bereaved families. Conclusions The stillbirth risk in both facilities was far higher than the risk recorded from national data, with women reporting a previous stillbirth being at higher risk. Women want to know the cause of stillbirth and an exploration of appropriate investigations in this setting is required. Providing health professionals with support and continuing training is key to improving the experiences of women and future care. Tweetable abstract Stillbirths receive little investigation and are often unexplained. Communication with women about the death of their baby is limited. Stillbirths receive little investigation and are often unexplained. Communication with women about the death of their baby is limited.
Collapse
Affiliation(s)
- C Bedwell
- International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - K Blaikie
- School of Health Sciences, University of Manchester, Manchester, UK
| | - V Actis Danna
- International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - C Sutton
- School of Health Sciences, University of Manchester, Manchester, UK
| | - R Laisser
- Archbishop Antony Mayala School of Nursing, Catholic University of Health and Allied Health Sciences, Mwanza, Tanzania
| | - C Tembo Kasengele
- Department of Public Health and Research, Ministry of Health Headquarters, Lusaka, Zambia
| | | | - S Victor
- Perinatal Imaging and Health, King's College London, London, UK
| | - T Lavender
- International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| |
Collapse
|
10
|
Understanding cause of stillbirth: a prospective observational multi-country study from sub-Saharan Africa. BMC Pregnancy Childbirth 2019; 19:470. [PMID: 31801488 PMCID: PMC6894270 DOI: 10.1186/s12884-019-2626-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 11/22/2019] [Indexed: 11/15/2022] Open
Abstract
Background Every year, an estimated 2.6 million stillbirths occur worldwide, with up to 98% occurring in low- and middle-income countries (LMIC). There is a paucity of primary data on cause of stillbirth from LMIC, and particularly from sub-Saharan Africa to inform effective interventions. This study aimed to identify the cause of stillbirths in low- and middle-income settings and compare methods of assessment. Methods This was a prospective, observational study in 12 hospitals in Kenya, Malawi, Sierra Leone and Zimbabwe. Stillbirths (28 weeks or more) were reviewed to assign the cause of death by healthcare providers, an expert panel and by using computer-based algorithms. Agreement between the three methods was compared using Kappa (κ) analysis. Cause of stillbirth and level of agreement between the methods used to assign cause of death. Results One thousand five hundred sixty-three stillbirths were studied. The stillbirth rate (per 1000 births) was 20.3 in Malawi, 34.7 in Zimbabwe, 38.8 in Kenya and 118.1 in Sierra Leone. Half (50.7%) of all stillbirths occurred during the intrapartum period. Cause of death (range) overall varied by method of assessment and included: asphyxia (18.5–37.4%), placental disorders (8.4–15.1%), maternal hypertensive disorders (5.1–13.6%), infections (4.3–9.0%), cord problems (3.3–6.5%), and ruptured uterus due to obstructed labour (2.6–6.1%). Cause of stillbirth was unknown in 17.9–26.0% of cases. Moderate agreement was observed for cause of stillbirth as assigned by the expert panel and by hospital-based healthcare providers who conducted perinatal death review (κ = 0.69; p < 0.0005). There was only minimal agreement between expert panel review or healthcare provider review and computer-based algorithms (κ = 0.34; 0.31 respectively p < 0.0005). Conclusions For the majority of stillbirths, an underlying likely cause of death could be determined despite limited diagnostic capacity. In these settings, more diagnostic information is, however, needed to establish a more specific cause of death for the majority of stillbirths. Existing computer-based algorithms used to assign cause of death require revision.
Collapse
|
11
|
Goergen SK, Alibrahim E, Govender N, Stanislavsky A, Abel C, Prystupa S, Collett J, Shelmerdine SC, Arthurs OJ. Diagnostic assessment of foetal brain malformations with intra-uterine MRI versus perinatal post-mortem MRI. Neuroradiology 2019; 61:921-934. [PMID: 31076826 PMCID: PMC6620257 DOI: 10.1007/s00234-019-02218-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 04/16/2019] [Indexed: 12/14/2022]
Abstract
PURPOSE To evaluate differences in diagnostic yield of intra-uterine foetal (iuMR) and post-mortem MRI (PMMR) for complex brain malformations, using autopsy as the reference standard. METHODS In this retrospective, multicentre study spanning 2 years, we reviewed 13 terminated singleton pregnancies with a prenatal ultrasound finding of complex foetal cerebral abnormalities, referred for both iuMR and PMMR. The iuMR and PMMR studies of the brain were reported independently by two groups of radiologists, blinded to each other's reports. Descriptive statistics were used to compare differences in intracranial abnormalities with autopsy (and genetic testing, where present) as reference standard. RESULTS The median gestational age at termination was 24.6 weeks (IQR 22-29) with median time between delivery and PMMR of 133 h (IQR 101-165). There was full concordance between iuMR and PMMR findings and autopsy in 2/13 (15.3%) cases. Partial concordance between both imaging modalities was present in 6/13 (46.2%) and total discordance in the remainder (5/13, 38.5%). When compared to autopsy, PMMR missed important key findings specifically for neuronal migration and cerebellar anomalies, whereas iuMR appeared to overcall CSF space abnormalities which were less crucial to reaching the final overall diagnosis. CONCLUSIONS iuMR should be performed to improve foetal phenotyping where there is a prenatal ultrasound for complex foetal brain abnormalities. Reliance on PMMR alone is likely to result in misdiagnosis in a majority of cases.
Collapse
Affiliation(s)
- Stacy K Goergen
- Monash Imaging, Clayton, Victoria, Australia
- School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Ekaterina Alibrahim
- Department of Medical Imaging, Royal Women's Hospital, Parkville, Victoria, Australia
| | - Nishentha Govender
- Department of Medical Imaging, Royal Women's Hospital, Parkville, Victoria, Australia
| | | | - Christian Abel
- Department of Medical Imaging, John Hunter Hospital, Newcastle, New South Wales, Australia
- Department of Anatomical Pathology, Monash Health, Clayton, Victoria, Australia
| | - Stacey Prystupa
- Department of Medical Imaging, John Hunter Hospital, Newcastle, New South Wales, Australia
- Department of Anatomical Pathology, Monash Health, Clayton, Victoria, Australia
| | - Jacquelene Collett
- Department of Anatomical Pathology, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Susan C Shelmerdine
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK.
- UCL Great Ormond Street Institute of Child Health, London, UK.
| | - Owen J Arthurs
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK
- UCL Great Ormond Street Institute of Child Health, London, UK
| |
Collapse
|
12
|
Duncan L. Editorial - Māori's women's health in New Zealand. Aust N Z J Obstet Gynaecol 2018; 58:E21-E22. [PMID: 30288734 DOI: 10.1111/ajo.12903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Leigh Duncan
- Hawke's Bay Hospital, Hawke's Bay District Health Board, Hastings, New Zealand
| |
Collapse
|