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Luque-Fernandez MA, Thomas A, Gelaye B, Racape J, Sanchez MJ, Williams MA. Secular trends in stillbirth by maternal socioeconomic status in Spain 2007-15: a population-based study of 4 million births. Eur J Public Health 2020; 29:1043-1048. [PMID: 31121034 PMCID: PMC6896972 DOI: 10.1093/eurpub/ckz086] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Introduction Stillbirth, one of the urgent concerns of preventable perinatal deaths, has wide-reaching consequences for society. We studied secular stillbirth trends by maternal socioeconomic status (SES) in Spain. Methods We developed a population-based observational study, including 4 083 919 births during 2007–15. We estimate stillbirth rates and secular trends by maternal SES. We also evaluated the joint effect of maternal educational attainment and the Human Development Index (HDI) of women’s country of origin on the risk of stillbirth. The data and statistical analysis can be accessed for reproducibility in a GitHub repository: https://github.com/migariane/Stillbirth Results We found a consistent pattern of socioeconomic inequalities in the risk of delivering a stillborn, mainly characterized by a persistently higher risk, over time, among women with lower SES. Overall, women from countries with low HDIs and low educational attainments had approximately a four times higher risk of stillbirth (RR: 4.44; 95%CI: 3.71–5.32). Furthermore, we found a paradoxical reduction of the stillbirth gap over time between the highest and the lowest SESs, which is mostly due to the significant and increasing trend of stillbirth risk among highly educated women of advanced maternal age. Conclusion Our findings highlight no improvement in stillbirth rates among women of lower SES and an increasing trend among highly educated women of advanced maternal age over recent years. Public health policies developing preventive programmes to reduce stillbirth rates among women with lower SES are needed as well as the necessity of further study to understand the growing trend of age-related stillbirths among highly educated women in Spain.
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Affiliation(s)
- Miguel Angel Luque-Fernandez
- Andalusian School of Public Health, Biomedical Research Institute of Granada, University of Granada, Granada, Spain.,Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Public Health School, Centre de Recherche Épidémiologie, Biostatistique et Recherche Clinique, Université Libre de Bruxelles, Brussels, Belgium.,Biomedical Research Networking Centres of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Aurielle Thomas
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Bizu Gelaye
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Judith Racape
- Public Health School, Centre de Recherche Épidémiologie, Biostatistique et Recherche Clinique, Université Libre de Bruxelles, Brussels, Belgium
| | - Maria Jose Sanchez
- Andalusian School of Public Health, Biomedical Research Institute of Granada, University of Granada, Granada, Spain.,Biomedical Research Networking Centres of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Michelle A Williams
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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2
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Nwokoro UU, Dahiru T, Olorukooba A, Daam CK, Waziri HS, Adebowale A, Waziri NE, Nguku P. Determinants of perinatal mortality in public secondary health facilities, Abuja Municipal Area Council, Federal Capital Territory, Abuja, Nigeria. Pan Afr Med J 2020; 37:114. [PMID: 33425147 PMCID: PMC7755356 DOI: 10.11604/pamj.2020.37.114.17108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 09/08/2020] [Indexed: 11/24/2022] Open
Abstract
Introduction in Nigeria, perinatal mortality rate remains high among births at the health facility. Births occur majorly at the secondary healthcare level in Abuja Municipal Area Council (AMAC) of the Federal Capital Territory (FCT). Identifying factors influencing perinatal deaths in this setting would inform interventions on perinatal deaths reduction. We assessed perinatal mortality and its determinants in public secondary health facilities in AMAC. Methods delivery and neonatal data from two selected public secondary health facilities between 2013 and 2016 were reviewed and we extracted maternal socio-demographics, obstetrics and neonatal data from hospital delivery, newborns´ admissions and discharge registers. Data were analyzed using descriptive statistics and Cox proportional hazard models (α = 5%). Results perinatal mortality rate was 129.5 per 1000 births. Asphyxia 475 (34.0%), neonatal infection 279 (20.0%) and prematurity 242 (17.3%) accounted for majority of the 1,398 perinatal deaths. Unbooked status [aHR = 1.8 (95% CI 1.4 - 2.2)], antepartum haemorrhage [aHR = 2.8 (95% CI 1.2 - 6.7)], previous perinatal death [aHR = 2.3 (95% CI 1.7 - 3.1)] and maternal age ≥ 35 years [aHR= 1.4 (95% CI 1.0 - 1.8)] were associated with increased risk of perinatal death. Conclusion perinatal mortality in the studied hospitals was high. Determinants of perinatal death were unbooked antenatal care (ANC) status, antepartum haemorrhage, previous perinatal death and high maternal age. Reducing perinatal deaths would require improving antenatal care attendance with healthcare staff identifying and targeting women at risk of pregnancy complications.
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Affiliation(s)
| | - Tukur Dahiru
- Department of Community Medicine, Faculty of Medicine, Ahmadu Bello University, Zaria, Nigeria
| | - Abdulhakeem Olorukooba
- Department of Community Medicine, Faculty of Medicine, Ahmadu Bello University, Zaria, Nigeria
| | | | | | - Ayo Adebowale
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
| | | | - Patrick Nguku
- Nigeria Field Epidemiology and Laboratory Training Program, Abuja, Nigeria
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3
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Monasta L, Giangreco M, Ancona E, Barbone F, Bet E, Boschian-Bailo P, Cacciaguerra G, Cagnacci A, Canton M, Casarotto M, Comar M, Contardo S, De Agostini M, De Seta F, Del Ben G, Di Loreto C, Driul L, Facchin S, Giornelli R, Ianni A, La Valle S, Londero AP, Manfè M, Maso G, Mugittu R, Olivuzzi M, Orsaria M, Pecile V, Pinzano R, Pirrone F, Quadrifoglio M, Ricci G, Ronfani L, Salviato T, Sandrigo E, Smiroldo S, Sorz A, Stampalija T, Urriza M, Vanin M, Verardi G, Alberico S. Retrospective study 2005-2015 of all cases of fetal death occurred at ≥23 gestational weeks, in Friuli Venezia Giulia, Italy. BMC Pregnancy Childbirth 2020; 20:384. [PMID: 32611322 PMCID: PMC7329413 DOI: 10.1186/s12884-020-03074-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 06/23/2020] [Indexed: 11/25/2022] Open
Abstract
Background Intrauterine fetal death (IUFD) is a tragic event and, despite efforts to reduce rates, its incidence remains difficult to reduce. The objective of the present study was to examine the etiological factors that contribute to the main causes and conditions associated with IUFD, over an 11-year period in a region of North-East Italy (Friuli Venezia Giulia) for which reliable data in available. Methods Retrospective analysis of all 278 IUFD cases occurred between 2005 and 2015 in pregnancies with gestational age ≥ 23 weeks. Results The incidence of IUFD was 2.8‰ live births. Of these, 30% were small for gestational age (SGA), with immigrant women being significantly over-represented. The share of SGA reached 35% in cases in which a maternal of fetal pathological condition was present, and dropped to 28% in the absence of associated pathology. In 78 pregnancies (28%) no pathology was recorded that could justify IUFD. Of all IUFDs, 11% occurred during labor, and 72% occurred at a gestational age above 30 weeks. Conclusion The percentage of IUFD cases for which no possible cause can be identified is quite high. Only the adoption of evidence-based diagnostic protocols, with integrated immunologic, genetic and pathologic examinations, can help reduce this diagnostic gap, contributing to the prevention of future IUFDs.
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Affiliation(s)
- Lorenzo Monasta
- Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy.
| | - Manuela Giangreco
- Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Emanuele Ancona
- SOC Ostetricia e Ginecologia, Policlinico S. Giorgio S.p.A, Pordenone, Italy
| | - Fabio Barbone
- Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Elisa Bet
- SC Ostetricia e Ginecologia Pordenone, Azienda per l'Assistenza Sanitaria N. 5 - Friuli Occidentale, Pordenone, Italy
| | - Pierino Boschian-Bailo
- SC Ostetricia e Ginecologia Gorizia - Monfalcone, Azienda per l'Assistenza Sanitaria N. 2 - Bassa Friulana-Isontina, Gorizia, Italy
| | - Giovanna Cacciaguerra
- SC Ostetricia e Ginecologia Palmanova - Latisana, Azienda per l'Assistenza Sanitaria N. 2 - Bassa Friulana-Isontina, Gorizia, Italy
| | - Angelo Cagnacci
- Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy.,Dipartimento di Area Medica, Università degli Studi di Udine, Udine, Italy
| | - Melania Canton
- Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Maddalena Casarotto
- SC Ostetricia e Ginecologia Pordenone, Azienda per l'Assistenza Sanitaria N. 5 - Friuli Occidentale, Pordenone, Italy
| | - Manola Comar
- Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy.,Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Simona Contardo
- SC Ostetricia e Ginecologia San Vito - Spilimbergo, Azienda per l'Assistenza Sanitaria N. 5 - Friuli Occidentale, Pordenone, Italy
| | - Michela De Agostini
- SC Ostetricia e Ginecologia Palmanova - Latisana, Azienda per l'Assistenza Sanitaria N. 2 - Bassa Friulana-Isontina, Gorizia, Italy
| | - Francesco De Seta
- Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy.,Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Giovanni Del Ben
- SOC Ostetricia e Ginecologia, Policlinico S. Giorgio S.p.A, Pordenone, Italy
| | - Carla Di Loreto
- Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy.,Dipartimento di Area Medica, Università degli Studi di Udine, Udine, Italy
| | - Lorenza Driul
- Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy.,Dipartimento di Area Medica, Università degli Studi di Udine, Udine, Italy
| | - Stefano Facchin
- SC Ostetricia e Ginecologia Palmanova - Latisana, Azienda per l'Assistenza Sanitaria N. 2 - Bassa Friulana-Isontina, Gorizia, Italy
| | - Roberta Giornelli
- SC Ostetricia e Ginecologia Gorizia - Monfalcone, Azienda per l'Assistenza Sanitaria N. 2 - Bassa Friulana-Isontina, Gorizia, Italy
| | - Annalisa Ianni
- SOC Ostetricia e Ginecologia San Daniele - Tolmezzo, Azienda per l'Assistenza Sanitaria N. 3 - Alto Friuli-Collinare-Medio Friuli, Gemona del Friuli, Udine, Italy
| | - Santo La Valle
- SOC Ostetricia e Ginecologia, Policlinico S. Giorgio S.p.A, Pordenone, Italy
| | | | - Marciano Manfè
- SOC Ostetricia e Ginecologia, Policlinico S. Giorgio S.p.A, Pordenone, Italy
| | - Gianpaolo Maso
- Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Raffaela Mugittu
- SC Ostetricia e Ginecologia Gorizia - Monfalcone, Azienda per l'Assistenza Sanitaria N. 2 - Bassa Friulana-Isontina, Gorizia, Italy
| | - Monica Olivuzzi
- SOC Ostetricia e Ginecologia San Daniele - Tolmezzo, Azienda per l'Assistenza Sanitaria N. 3 - Alto Friuli-Collinare-Medio Friuli, Gemona del Friuli, Udine, Italy
| | - Maria Orsaria
- Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Vanna Pecile
- Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Roberta Pinzano
- SC Ostetricia e Ginecologia San Vito - Spilimbergo, Azienda per l'Assistenza Sanitaria N. 5 - Friuli Occidentale, Pordenone, Italy
| | - Francesco Pirrone
- SC Ostetricia e Ginecologia Pordenone, Azienda per l'Assistenza Sanitaria N. 5 - Friuli Occidentale, Pordenone, Italy
| | | | - Giuseppe Ricci
- Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy.,Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Luca Ronfani
- Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | | | - Elisa Sandrigo
- SC Ostetricia e Ginecologia Gorizia - Monfalcone, Azienda per l'Assistenza Sanitaria N. 2 - Bassa Friulana-Isontina, Gorizia, Italy
| | - Silvia Smiroldo
- SOC Ostetricia e Ginecologia, Policlinico S. Giorgio S.p.A, Pordenone, Italy
| | - Alice Sorz
- Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Tamara Stampalija
- Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy.,Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Marianela Urriza
- Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Michele Vanin
- SOC Ostetricia e Ginecologia San Daniele - Tolmezzo, Azienda per l'Assistenza Sanitaria N. 3 - Alto Friuli-Collinare-Medio Friuli, Gemona del Friuli, Udine, Italy
| | - Giuseppina Verardi
- Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Salvatore Alberico
- Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
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4
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Vergara-Duarte M, Borrell C, Pérez G, Martín-Sánchez JC, Clèries R, Buxó M, Martínez-Solanas È, Yasui Y, Muntaner C, Benach J. Sentinel Amenable Mortality: A New Way to Assess the Quality of Healthcare by Examining Causes of Premature Death for Which Highly Efficacious Medical Interventions Are Available. BIOMED RESEARCH INTERNATIONAL 2018; 2018:5456074. [PMID: 30246022 PMCID: PMC6139231 DOI: 10.1155/2018/5456074] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 02/08/2018] [Accepted: 05/09/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Amenable mortality, or premature deaths that could be prevented with medical care, is a proven indicator for assessing healthcare quality when adapted to a country or region's specific healthcare context. This concept is currently used to evaluate the performance of national and international healthcare systems. However, the levels of efficacy and effectiveness determined using this indicator can vary greatly depending on the causes of death that are included. We introduce a new approach by identifying a subgroup of causes for which there are available treatments with a high level of efficacy. These causes should be considered sentinel events to help identify limitations in the effectiveness and quality of health provision. METHODS We conducted an extensive literature review using a list of amenable causes of death compiled by Spanish researchers. We complemented this approach by assessing the time trends of amenable mortality in two high-income countries that have a similar quality of healthcare but very different systems of provision, namely, Spain and the United States. This enabled us to identify different levels of efficacy of medical interventions (high, medium, and low). We consulted a group of medical experts and combined this information to help make the final classification of sentinel amenable causes of death. RESULTS Sentinel amenable mortality includes causes such as surgical conditions, thyroid diseases, and asthma. The remaining amenable causes of death either have a higher complexity in terms of the disease or need more effective medical interventions or preventative measures to guarantee early detection and adherence to treatment. These included cardiovascular diseases, diabetes, hypertension, all amenable cancers, and some infectious diseases such as pneumonia, influenza, and tuberculosis. CONCLUSIONS Sentinel amenable mortality could act as a good sentinel indicator to identify major deficiencies in healthcare quality and provision and detect inequalities across populations.
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Affiliation(s)
- Montse Vergara-Duarte
- CAP El Clot and Unitat d'Avaluació, Sistemes d'Informació i Qualitat Assistencial, Gerència Territorial de Barcelona, Institut Català de la Salut, Departament de Salut, Generalitat de Catalunya, Barcelona, Spain
| | - Carme Borrell
- Agència de Salut Pública de Barcelona, Barcelona, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain
| | - Glòria Pérez
- Agència de Salut Pública de Barcelona, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain
| | - Juan Carlos Martín-Sánchez
- Biostatistics Unit, Department of Basic Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain
| | - Ramon Clèries
- Pla Director d'Oncología, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
- Departament de Ciències Clíniques, Universitat de Barcelona, Barcelona, Spain
| | - Maria Buxó
- Girona Biomedical Research Institute (IDIBGI), Salt, Spain
| | - Èrica Martínez-Solanas
- CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- ISGlobal, Center for Research in Environmental Epidemiology (CREAL), Spain
| | - Yutaka Yasui
- Department of Epidemiology & Cancer Control (S6050), St. Jude Children's Research Hospital, Memphis, TN, USA
- School of Public Health, University of Alberta, 4-274, Edmonton Clinic Health Academy, Edmonton, AB, Canada
| | - Carles Muntaner
- Bloomberg Faculty of Nursing and Dalla Lana School of Public Health, University of Toronto, Canada
| | - Joan Benach
- Health Inequalities Research Group-Employment Conditions Network (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona, Spain
- Johns Hopkins University, Public Policy Center, Barcelona, Spain
- Grupo de Investigación Transdisciplinar sobre Transiciones Socioecológicas (GinTRANS2), Universidad Autónoma de Madrid, Madrid, Spain
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5
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Vitral GLN, Aguiar RAPL, de Souza IMF, Rego MAS, Guimarães RN, Reis ZSN. Skin thickness as a potential marker of gestational age at birth despite different fetal growth profiles: A feasibility study. PLoS One 2018; 13:e0196542. [PMID: 29698511 PMCID: PMC5919437 DOI: 10.1371/journal.pone.0196542] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 04/14/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND New methodologies to estimate gestational age (GA) at birth are demanded to face the limited access to obstetric ultrasonography and imprecision of postnatal scores. The study analyzed the correlation between neonatal skin thickness and pregnancy duration. Secondarily, it investigated the influence of fetal growth profiles on tissue layer dimensions. METHODS AND FINDINGS In a feasibility study, 222 infants selected at a term-to-preterm ratio of 1:1 were assessed. Reliable information on GA was based on the early ultrasonography-based reference. The thicknesses of the epidermal and dermal skin layers were examined using high-frequency ultrasonography. We scanned the skin over the forearm and foot plantar surface of the newborns. A multivariate regression model was adjusted to determine the correlation of GA with skin layer dimensions. The best model to correlate skin thickness with GA was fitted using the epidermal layer on the forearm site, adjusted to cofactors, as follows: Gestational age (weeks) = -28.0 + 12.8 Ln (Thickness) - 4.4 Incubator staying; R2 = 0.604 (P<0.001). In this model, the constant value for the standard of fetal growth was statistically null. The dermal layer thickness on the forearm and plantar surfaces had a negative moderate linear correlation with GA (R = -0.370, P<0.001 and R = -0.421, P<0.001, respectively). The univariate statistical analyses revealed the influence of underweight and overweight profiles on neonatal skin thickness at birth. Of the 222 infants, 53 (23.9%) had inappropriate fetal growths expected for their GA. Epidermal thickness was not fetal growth standard dependent as follows: 172.2 (19.8) μm for adequate for GA, 171.4 (20.6) μm for SGA, and 177.7 (15.2) μm for LGA (P = 0.525, mean [SD] on the forearm). CONCLUSIONS The analysis highlights a new opportunity to relate GA at birth to neonatal skin layer thickness. As this parameter was not influenced by the standard of fetal growth, skin maturity can contribute to clinical applications.
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Affiliation(s)
- Gabriela Luiza Nogueira Vitral
- Postgraduation Program of Women’s Health, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Regina Amélia P. Lopes Aguiar
- Postgraduation Program of Women’s Health, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Department of Gynecology and Obstetrics, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Ingrid Michelle Fonseca de Souza
- Postgraduation Program of Women’s Health, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Maria Albertina Santiago Rego
- Department of Pediatrics, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Rodney Nascimento Guimarães
- Postgraduation Program of Women’s Health, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Department of Gynecology and Obstetrics, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Zilma Silveira Nogueira Reis
- Postgraduation Program of Women’s Health, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Department of Gynecology and Obstetrics, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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6
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Sharifi N, Khazaeian S, Pakzad R, Fathnezhad Kazemi A, Chehreh H. Investigating the Prevalence of Preterm Birth in Iranian Population: A Systematic Review and Meta-Analysis. J Caring Sci 2017; 6:371-380. [PMID: 29302576 PMCID: PMC5747595 DOI: 10.15171/jcs.2017.035] [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: 02/24/2017] [Accepted: 08/10/2017] [Indexed: 01/22/2023] Open
Abstract
Introduction: Despite medical advances, preterm delivery remains a global problem in
developed and developing countries. The present study was aimed at conducting a
systematic review and meta-analysis of studies on the prevalence of preterm delivery in
Iran.
Methods: This study was carried out on studies conducted in Iran by searching
databases of SID, Magiran, Irandoc, MEDLIB, Iranmedex, PubMed, Web of science,
Google Scholar and Scopus. The search was conducted using advanced search and
keywords of preterm delivery and equivalents of it in Mesh and their Farsi’s
Synonymous in all articles from 2000-2016.After extracting the data, the data were
combined using a random model. Heterogeneity of the studies was assessed using Q
test I2 index and the data were analyzed using STATA Ver.11 software.
Results: The total number of samples in this study was 41773. In 19 reviewed articles,
the overall prevalence of preterm delivery, based on the random effects model, was
estimated to be a total of 10% (95% CI, 9-12). The lowest prevalence of preterm labor
was 5.4% in Bam and the highest prevalence was 19.85% in Tehran. There was no
significant difference between the prevalence of preterm delivery compared to year of
study and sample size.
Conclusion: This study reviewed the findings of previous studies and showed that
preterm delivery is a relatively prevalent problem in Iran. Therefore, adopting
appropriate interventions in many cases including life skills training, self-care and
increasing pregnancy care to reduce these consequences and their following
complications in high risk patients seem necessary.
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Affiliation(s)
- Nasibeh Sharifi
- Departmant of Midwifery, Faculty of Nursing and Midwifery, Ilam Univesity of Medical Science, Ilam, Iran
| | - Somayyeh Khazaeian
- Departmant of Midwifery, Pregnancy Health Research Center, School of Nursing and Midwifery, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Reza Pakzad
- Department of Epidemiology, Faculty of Health, Ilam University of Medical Sciences, Ilam, Iran
| | - Azita Fathnezhad Kazemi
- Department of Midwifery, Faculty of Nursing and Midwifery, Islamic Azad University of Tabriz, Tabriz, Iran.,Student Research Committee, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hashemmieh Chehreh
- Student Research Committee, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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7
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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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8
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Biodemographic Analysis of Factors Related to Perinatal Mortality in Portugal (1988-2011). Int J Pediatr 2016; 2016:6123065. [PMID: 27867399 PMCID: PMC5102729 DOI: 10.1155/2016/6123065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 08/27/2016] [Accepted: 09/18/2016] [Indexed: 11/18/2022] Open
Abstract
Background. The purpose of this paper is to determine the relative mortality risks at delivery and during the first week of life with regard to maternal and foetal characteristics. Methods. Yearly individual digital records on live births and early neonatal mortality were used to infer the possible factors involved in perinatal deaths. Results. The results show that the number of births per year declined with time throughout the period studied. At the same time, rates decreased in 66.4% for stillbirths and in 70.2% for early neonatal mortality. Logistic regressions modelled the interaction of the two mortality indicators and covariables such as birth weight and the duration of gestation. Conclusions. This research provides a first biodemographic approach to the knowledge of factors influencing perinatal mortality in Portugal based on a set of foetal and maternal variables. Although the magnitude of the different perinatal mortality rates may be affected by the criteria used for selecting cases (multiple-singletons; minimum birth weight or minimum duration of gestation), one of the conclusions of the present analysis is that the relationship among the maternal and foetal variables that determine the relative risk remains unaltered. Certain resemblance with the factors determining negative birth outcomes in Spain is appreciated.
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9
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Delnord M, Hindori-Mohangoo AD, Smith LK, Szamotulska K, Richards JL, Deb-Rinker P, Rouleau J, Velebil P, Zile I, Sakkeus L, Gissler M, Morisaki N, Dolan SM, Kramer MR, Kramer MS, Zeitlin J. Variations in very preterm birth rates in 30 high-income countries: are valid international comparisons possible using routine data? BJOG 2016; 124:785-794. [PMID: 27613083 DOI: 10.1111/1471-0528.14273] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Concerns about differences in registration practices across countries have limited the use of routine data for international very preterm birth (VPT) rate comparisons. DESIGN Population-based study. SETTING Twenty-seven European countries, the United States, Canada and Japan in 2010. POPULATION A total of 9 376 252 singleton births. METHOD We requested aggregated gestational age data on live births, stillbirths and terminations of pregnancy (TOP) before 32 weeks of gestation, and information on registration practices for these births. We compared VPT rates and assessed the impact of births at 22-23 weeks of gestation, and different criteria for inclusion of stillbirths and TOP on country rates and rankings. MAIN OUTCOME MEASURES Singleton very preterm birth rate, defined as singleton stillbirths and live births before 32 completed weeks of gestation per 1000 total births, excluding TOP if identifiable in the data source. RESULTS Rates varied from 5.7 to 15.7 per 1000 total births and 4.0 to 11.9 per 1000 live births. Country registration practices were related to percentage of births at 22-23 weeks of gestation (between 1% and 23% of very preterm births) and stillbirths (between 6% and 40% of very preterm births). After excluding births at 22-23 weeks, rate variations remained high and with a few exceptions, country rankings were unchanged. CONCLUSIONS International comparisons of very preterm birth rates using routine data should exclude births at 22-23 weeks of gestation and terminations of pregnancy. The persistent large rate variations after these exclusions warrant continued surveillance of VPT rates at 24 weeks and over in high-income countries. TWEETABLE ABSTRACT International comparisons of VPT rates should exclude births at 22-23 weeks of gestation and terminations of pregnancy.
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Affiliation(s)
- M Delnord
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Centre for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - A D Hindori-Mohangoo
- Department Child Health, TNO, The Netherlands Organisation for Applied Scientific Research, Leiden, The Netherlands.,Department Public Health, Faculty of Medical Sciences, Anton de Kom University of Suriname, Paramaribo, Suriname
| | - L K Smith
- The Infant Mortality and Morbidity Studies Group (TIMMS), Department of Health Sciences, College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, UK
| | - K Szamotulska
- Department of Epidemiology and Biostatistics, National Research Institute of Mother and Child, Warsaw, Poland
| | - J L Richards
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - P Deb-Rinker
- Surveillance and Epidemiology Division, Centre for Chronic Disease Prevention, Public Health Agency of Canada, Ottawa, ON, Canada
| | - J Rouleau
- Surveillance and Epidemiology Division, Centre for Chronic Disease Prevention, Public Health Agency of Canada, Ottawa, ON, Canada
| | - P Velebil
- Institute for the Care of Mother and Child, Prague, Czech Republic
| | - I Zile
- Centre for Disease Prevention and Control of Latvia, Riga, Latvia
| | - L Sakkeus
- Estonian Institute for Population Studies, Tallinn University, Tallinn, Estonia
| | - M Gissler
- THL National Institute for Health and Welfare, Helsinki, Finland.,Karolinska Institute, Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Stockholm, Sweden
| | - N Morisaki
- Department of Lifecourse Epidemiology, Department of Social Medicine, National Centre for Child Health and Development, Setagayaku, Tokyo, Japan
| | - S M Dolan
- Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - M R Kramer
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - M S Kramer
- Departments of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, QC, Canada
| | - J Zeitlin
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Centre for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
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Chen A, Oster E, Williams H. Why Is Infant Mortality Higher in the United States Than in Europe? AMERICAN ECONOMIC JOURNAL. ECONOMIC POLICY 2016; 8:89-124. [PMID: 27158418 PMCID: PMC4856058 DOI: 10.1257/pol.20140224] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
The US has higher infant mortality than peer countries. In this paper, we combine micro-data from the US with similar data from four European countries to investigate this US infant mortality disadvantage. The US disadvantage persists after adjusting for potential di erential reporting of births near the threshold of viability. While the importance of birth weight varies across comparison countries, relative to all comparison countries the US has similar neonatal (<1 month) mortality but higher postneonatal (1-12 months) mortality. We document similar patterns across Census divisions within the US. The postneonatal mortality disadvantage is driven by poor birth outcomes among lower socioeconomic status individuals.
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11
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Zeitlin J, Mortensen L, Cuttini M, Lack N, Nijhuis J, Haidinger G, Blondel B, Hindori-Mohangoo AD. Declines in stillbirth and neonatal mortality rates in Europe between 2004 and 2010: results from the Euro-Peristat project. J Epidemiol Community Health 2015; 70:609-15. [PMID: 26719590 PMCID: PMC4893141 DOI: 10.1136/jech-2015-207013] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 12/01/2015] [Indexed: 12/02/2022]
Abstract
Background Stillbirth and neonatal mortality rates declined in Europe between 2004 and 2010. We hypothesised that declines might be greater for countries with higher mortality in 2004 and disproportionally affect very preterm infants at highest risk. Methods Data about live births, stillbirths and neonatal deaths by gestational age (GA) were collected using a common protocol by the Euro-Peristat project in 2004 and 2010. We analysed stillbirths at ≥28 weeks GA in 22 countries and live births ≥24 weeks GA for neonatal mortality in 18 countries. Per cent changes over time were assessed by calculating risk ratios (RR) for stillbirth, neonatal mortality and preterm birth rates in 2010 vs 2004. We used meta-analysis techniques to derive pooled RR using random-effects models overall, by GA subgroups and by mortality level in 2004. Results Between 2004 and 2010, stillbirths declined by 17% (95% CI 10% to 23%), with a range from 1% to 39% by country. Neonatal mortality declined by 29% (95% CI 23% to 35%) with a range from 9% to 67%. Preterm birth rates did not change: 0% (95% CI −3% to 3%). Mortality declines were of a similar magnitude at all GA; mortality levels in 2004 were not associated with RRs. Conclusions Stillbirths and neonatal deaths declined at all gestational ages in countries with both high and low levels of mortality in 2004. These results raise questions about how low-mortality countries achieve continued declines and highlight the importance of improving care across the GA spectrum.
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Affiliation(s)
- Jennifer Zeitlin
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, France
| | - Laust Mortensen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark Methodology and Analysis, Statistics Denmark, Copenhagen, Denmark
| | - Marina Cuttini
- Research Unit of Perinatal Epidemiology, Bambino Gesu Children's Hospital, Rome, Italy
| | - Nicholas Lack
- Department of Methods and Perinatology, BAQ, Bavarian Institute for Quality Assurance, Munich, Germany
| | - Jan Nijhuis
- Department of Obstetrics and Gynaecology, GROW School of Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Gerald Haidinger
- Department of Epidemiology, Centre for Public Health, Medical University of Vienna, Vienna, Austria
| | - Béatrice Blondel
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, France
| | - Ashna D Hindori-Mohangoo
- Department Child Health, Netherlands Organization for Applied Scientific Research, TNO Healthy Living, Leiden, The Netherlands
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12
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Osterman MJ, Kochanek KD, MacDorman MF, Strobino DM, Guyer B. Annual summary of vital statistics: 2012-2013. Pediatrics 2015; 135:1115-25. [PMID: 25941306 PMCID: PMC4750477 DOI: 10.1542/peds.2015-0434] [Citation(s) in RCA: 123] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/26/2015] [Indexed: 11/24/2022] Open
Abstract
The number of births in the United States declined by 1% between 2012 and 2013, to a total of 3 932 181. The general fertility rate also declined 1% to 62.5 births per 1000 women, the lowest rate ever reported. The total fertility rate was down by 1% in 2013 (to 1857.5 births per 1000 women). The teenage birth rate fell to another historic low in 2013, 26.5 births per 1000 women. Birth rates also declined for women 20 to 29 years, but the rates rose for women 30 to 39 and were unchanged for women 40 to 44. The percentage of all births that were to unmarried women declined slightly to 40.6% in 2013, from 40.7% in 2012. In 2013, the cesarean delivery rate declined to 32.7% from 32.8% for 2012. The preterm birth rate declined for the seventh straight year in 2013 to 11.39%; the low birth weight (LBW) rate was essentially unchanged at 8.02%. The infant mortality rate was 5.96 infant deaths per 1000 live births in 2013, down 13% from 2005 (6.86). The age-adjusted death rate for 2013 was 7.3 deaths per 1000 population, unchanged from 2012. Crude death rates for children aged 1 to 19 years declined to 24.0 per 100 000 population in 2013, from 24.8 in 2012. Unintentional injuries and suicide were, respectively, the first and second leading causes of death in this age group. These 2 causes of death jointly accounted for 45.7% of all deaths to children and adolescents in 2013.
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Affiliation(s)
- Michelle J.K. Osterman
- Division of Vital Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland; and,Address correspondence to to Michelle J.K. Osterman, MHS, Centers for Disease Control and Prevention, National Center for Health Statistics, 3311 Toledo Rd, Rm 7414, Hyattsville, MD 20782. E-mail:
| | - Kenneth D. Kochanek
- Division of Vital Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland; and
| | - Marian F. MacDorman
- Division of Vital Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland; and
| | - Donna M. Strobino
- Department of Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Bernard Guyer
- Department of Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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13
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Arora CP, Kacerovsky M, Zinner B, Ertl T, Ceausu I, Rusnak I, Shurpyak S, Sandhu M, Hobel CJ, Dumesic DA, Vari SG. Disparities and relative risk ratio of preterm birth in six Central and Eastern European centers. Croat Med J 2015; 56:119-27. [PMID: 25891871 PMCID: PMC4410174 DOI: 10.3325/cmj.2015.56.119] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 03/31/2015] [Indexed: 01/26/2023] Open
Abstract
AIM To identify characteristic risk factors of preterm birth in Central and Eastern Europe and explore the differences from other developed countries. METHOD Data on 33,794 term and 3867 preterm births (<37 wks.) were extracted in a retrospective study between January 1, 2007 and December 31, 2009. The study took place in 6 centers in 5 countries: Czech Republic, Hungary (two centers), Romania, Slovakia, and Ukraine. Data on historical risk factors, pregnancy complications, and special testing were gathered. Preterm birth frequencies and relevant risk factors were analyzed using Statistical Analysis System (SAS) software. RESULTS All the factors selected for study (history of smoking, diabetes, chronic hypertension, current diabetes, preeclampsia, progesterone use, current smoking, body mass index, iron use and anemia during pregnancy), except the history of diabetes were predictive of preterm birth across all participating European centers. Preterm birth was at least 2.4 times more likely with smoking (history or current), three times more likely with preeclampsia, 2.9 times more likely with hypertension after adjusting for other covariates. It had inverse relationship with the significant predictor body mass index, with adjusted risk ratio of 0.8 to 1.0 in three sites. Iron use and anemia, though significant predictors of preterm birth, indicated mixed patterns for relative risk ratio. CONCLUSION Smoking, preeclampsia, hypertension and body mass index seem to be the foremost risk factors of preterm birth. Implications of these factors could be beneficial for design and implementation of interventions and improve the birth outcome.
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Affiliation(s)
- Chander P Arora
- Chander P Arora, International Research and Innovation Management Program, Cedars-Sinai Medical Center, 6420 Wilshire Blvd. Suite # 301, Los Angeles, California 90048, USA,
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14
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Pinar H, Goldenberg RL, Koch MA, Heim-Hall J, Hawkins HK, Shehata B, Abramowsky C, Parker CB, Dudley DJ, Silver RM, Stoll B, Carpenter M, Saade G, Moore J, Conway D, Varner MW, Hogue CJ, Coustan DR, Sbrana E, Thorsten V, Willinger M, Reddy UM. Placental findings in singleton stillbirths. Obstet Gynecol 2014; 123:325-336. [PMID: 24402599 PMCID: PMC3948332 DOI: 10.1097/aog.0000000000000100] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare placental lesions for stillbirth cases and live birth controls in a population-based study. METHODS Pathologic examinations were performed on placentas from singleton pregnancies using a standard protocol. Data were analyzed overall and within gestational age groups at delivery. RESULTS Placentas from 518 stillbirths and 1,200 live births were studied. Single umbilical artery was present in 7.7% of stillbirths and 1.7% of live births, velamentous cord insertion was present in 5% of stillbirths and 1.1% of live births, diffuse terminal villous immaturity was present in 10.3% of stillbirths and 2.3% of live births, inflammation (eg, acute chorioamnionitis of placental membranes) was present in 30.4% of stillbirths and 12% of live births, vascular degenerative changes in chorionic plate were present in 55.7% of stillbirths and 0.5% of live births, retroplacental hematoma was present in 23.8% of stillbirths and 4.2% of live births, intraparenchymal thrombi was present in 19.7% of stillbirths and 13.3% of live births, parenchymal infarction was present in 10.9% of stillbirths and 4.4% of live births, fibrin deposition was present in 9.2% of stillbirths and 1.5% of live births, fetal vascular thrombi was present in 23% of stillbirths and 7% of live births, avascular villi was present in 7.6% of stillbirths and 2.0% of live births, and hydrops was present in 6.4% of stillbirths and 1.0% of live births. Among stillbirths, inflammation and retroplacental hematoma were more common in placentas from early deliveries, whereas thrombotic lesions were more common in later gestation. Inflammatory lesions were especially common in early live births. CONCLUSIONS Placental lesions were highly associated with stillbirth compared with live births. All lesions associated with stillbirth were found in live births but often with variations by gestational age at delivery. Knowledge of lesion prevalence within gestational age groups in both stillbirths and live birth controls contributes to an understanding of the association between placental abnormality and stillbirth. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Halit Pinar
- The Warren Alpert Medical School of Brown University
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Deborah Conway
- University of Texas Health Science Center at San Antonio
| | | | | | | | | | | | - Marian Willinger
- Eunice Kennedy Shriver National Institute of Child Health and Human Development
| | - Uma M. Reddy
- Eunice Kennedy Shriver National Institute of Child Health and Human Development
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Dolatian M, Mirabzadeh A, Forouzan AS, Sajjadi H, Alavi Majd H, Moafi F. Preterm delivery and psycho-social determinants of health based on World Health Organization model in Iran: a narrative review. Glob J Health Sci 2012; 5:52-64. [PMID: 23283036 PMCID: PMC4777007 DOI: 10.5539/gjhs.v5n1p52] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2012] [Revised: 11/04/2012] [Accepted: 10/22/2012] [Indexed: 12/03/2022] Open
Abstract
Background: Preterm delivery is still the primary cause of mortality and morbidity in infants, which shows a problematic condition in the care of pregnant women all over the world. This review study describes prevalence and psycho - socio-demographic as well as obstetrical risk factors related to live preterm delivery (PTD) in the recent decade in Iran. Methods: A narrative review was performed in Persian and international databases including PubMed, SID, Google Scholar, Iran Medex, Magiran and Irandoc from 2001 to 2010 with following keywords: preterm delivery and pregnancy outcomes with (prevalence, socioeconomic condition, structural determinant, Intermediary determinants, Psychosocial factor, Behavioral factor and Maternal circumstance, Health system) All of article was reviewed then categorized based on WHO model. Results: Totally 52 article were reviewed and 35 articles were selected, of which 26 were cross-sectional or longitudinal, 9 were analytical (cohort or case-control). The prevalence rates of preterm delivery in different cities of Iran were reported between 5.6% in Quom to 39.4% in Kerman. The most common social factors in structural determinant were educational level of mother, and in intermediary determinants were Psychosocial factor (maternal anxiety and stress during pregnancy), Behavioral factor and Maternal circumstance (violation and trauma) and in Health system, lack of prenatal care. Conclusion: The prevalence rate of preterm delivery is a matter of concern. Since many psycho-social factors may affect on the condition and its high rate in poor communities might reveals a causal relationship among biological and psychosocial factors, performing etiological investigations is recommended.
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Affiliation(s)
- Mahrokh Dolatian
- Social Determinants of Health Research Center , University of Social Welfare and Rehabilitation Sciences, Tehran , Iran.
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Abstract
Monitoring development indicators has become a central interest of international agencies and countries for tracking progress towards the Millennium Development Goals. In this review, which also provides an introduction to a collection of articles, we describe the methodology used by the United Nations Inter-agency Group for Child Mortality Estimation to track country-specific changes in the key indicator for Millennium Development Goal 4 (MDG 4), the decline of the under-five mortality rate (the probability of dying between birth and age five, also denoted in the literature as U5MR and (5)q(0)). We review how relevant data from civil registration, sample registration, population censuses, and household surveys are compiled and assessed for United Nations member states, and how time series regression models are fitted to all points of acceptable quality to establish the trends in U5MR from which infant and neonatal mortality rates are generally derived. The application of this methodology indicates that, between 1990 and 2010, the global U5MR fell from 88 to 57 deaths per 1,000 live births, and the annual number of under-five deaths fell from 12.0 to 7.6 million. Although the annual rate of reduction in the U5MR accelerated from 1.9% for the period 1990-2000 to 2.5% for the period 2000-2010, it remains well below the 4.4% annual rate of reduction required to achieve the MDG 4 goal of a two-thirds reduction in U5MR from its 1990 value by 2015. Thus, despite progress in reducing child mortality worldwide, and an encouraging increase in the pace of decline over the last two decades, MDG 4 will not be met without greatly increasing efforts to reduce child deaths.
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Abstract
CONTEXT Stillbirth affects 1 in 160 pregnancies in the United States, equal to the number of infant deaths each year. Rates are higher than those of other developed countries and have stagnated over the past decade. There is significant racial disparity in the rate of stillbirth that is unexplained. OBJECTIVE To ascertain the causes of stillbirth in a population that is diverse by race/ethnicity and geography. DESIGN, SETTING, AND PARTICIPANTS A population-based study from March 2006 to September 2008 with surveillance for all stillbirths at 20 weeks or later in 59 tertiary care and community hospitals in 5 catchment areas defined by state and county boundaries to ensure access to at least 90% of all deliveries. Termination of a live fetus was excluded. Standardized evaluations were performed at delivery. MAIN OUTCOME MEASURES Medical history, fetal postmortem and placental pathology, karyotype, other laboratory tests, systematic assignment of causes of death. RESULTS Of 663 women with stillbirth enrolled, 500 women consented to complete postmortem examinations of 512 neonates. A probable cause of death was found in 312 stillbirths (60.9%; 95% CI, 56.5%-65.2%) and possible or probable cause in 390 (76.2%; 95% CI, 72.2%-79.8%). The most common causes were obstetric conditions (150 [29.3%; 95% CI, 25.4%-33.5%]), placental abnormalities (121 [23.6%; 95% CI, 20.1%-27.6%]), fetal genetic/structural abnormalities (70 [13.7%; 95% CI, 10.9%-17.0%]), infection (66 [12.9%; 95% CI, 10.2%-16.2%]), umbilical cord abnormalities (53 [10.4%; 95% CI, 7.9%-13.4%]), hypertensive disorders (47 [9.2%; 95% CI, 6.9%-12.1%]), and other maternal medical conditions (40 [7.8%; 95% CI, 5.7%-10.6%]). A higher proportion of stillbirths in non-Hispanic black women compared with non-Hispanic white and Hispanic ones was associated with obstetric complications (43.5% [50] vs 23.7% [85]; difference, 19.8%; 95% CI, 9.7%-29.9%; P < .001) and infections (25.2% [29] vs 7.8% [28]; difference, 17.4%; 95% CI, 9.0%-25.8%; P < .001). Stillbirths occurring intrapartum and early in gestation were more common in non-Hispanic black women. Sources most likely to provide positive information regarding cause of death were placental histology (268 [52.3%; 95% CI, 47.9%-56.7%]), perinatal postmortem examination (161 [31.4%; 95% CI, 27.5%-35.7%]), and karyotype (32 of 357 with definitive results [9%; 95% CI, 6.3%-12.5%]). CONCLUSIONS A systematic evaluation led to a probable or possible cause in the majority of stillbirths. Obstetric conditions and placental abnormalities were the most common causes of stillbirth, although the distribution differed by race/ethnicity.
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Affiliation(s)
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- Department of Obstetrics and Gynecology, University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT 84132, USA
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18
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Mohangoo AD, Buitendijk SE, Szamotulska K, Chalmers J, Irgens LM, Bolumar F, Nijhuis JG, Zeitlin J. Gestational age patterns of fetal and neonatal mortality in Europe: results from the Euro-Peristat project. PLoS One 2011; 6:e24727. [PMID: 22110575 PMCID: PMC3217927 DOI: 10.1371/journal.pone.0024727] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Accepted: 08/19/2011] [Indexed: 01/12/2023] Open
Abstract
Background The first European Perinatal Health Report showed wide variability between European countries in fetal (2.6–9.1‰) and neonatal (1.6–5.7‰) mortality rates in 2004. We investigated gestational age patterns of fetal and neonatal mortality to improve our understanding of the differences between countries with low and high mortality. Methodology/Principal Findings Data on 29 countries/regions participating in the Euro-Peristat project were analyzed. Most European countries had no limits for the registration of live births, but substantial variations in limits for registration of stillbirths before 28 weeks of gestation existed. Country rankings changed markedly after excluding deaths most likely to be affected by registration differences (22–23 weeks for neonatal mortality and 22–27 weeks for fetal mortality). Countries with high fetal mortality ≥28 weeks had on average higher proportions of fetal deaths at and near term (≥37 weeks), while proportions of fetal deaths at earlier gestational ages (28–31 and 32–36 weeks) were higher in low fetal mortality countries. Countries with high neonatal mortality rates ≥24 weeks, all new member states of the European Union, had high gestational age-specific neonatal mortality rates for all gestational-age subgroups; they also had high fetal mortality, as well as high early and late neonatal mortality. In contrast, other countries with similar levels of neonatal mortality had varying levels of fetal mortality, and among these countries early and late neonatal mortality were negatively correlated. Conclusions For valid European comparisons, all countries should register births and deaths from at least 22 weeks of gestation and should be able to distinguish late terminations of pregnancy from stillbirths. After excluding deaths most likely to be influenced by existing registration differences, important variations in both levels and patterns of fetal and neonatal mortality rates were found. These disparities raise questions for future research about the effectiveness of medical policies and care in European countries.
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Affiliation(s)
- Ashna D Mohangoo
- Department Child Health, TNO Netherlands Organization for Applied Scientific Research, Leiden, The Netherlands.
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19
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Gissler M, Mohangoo AD, Blondel B, Chalmers J, Macfarlane A, Gaizauskiene A, Gatt M, Lack N, Sakkeus L, Zeitlin J. Perinatal health monitoring in Europe: results from the EURO-PERISTAT project. Inform Health Soc Care 2010; 35:64-79. [PMID: 20726736 DOI: 10.3109/17538157.2010.492923] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Data about deliveries, births, mothers and newborn babies are collected extensively to monitor the health and care of mothers and babies during pregnancy, delivery and the post-partum period, but there is no common approach in Europe. We analysed the problems related to using the European data for international comparisons of perinatal health. We made an inventory of relevant data sources in 25 European Union (EU) member states and Norway, and collected perinatal data using a previously defined indicator list. The main sources were civil registration based on birth and death certificates, medical birth registers, hospital discharge systems, congenital anomaly registers, confidential enquiries and audits. A few countries provided data from routine perinatal surveys or from aggregated data collection systems. The main methodological problems were related to differences in registration criteria and definitions, coverage of data collection, problems in combining information from different sources, missing data and random variation for rare events. Collection of European perinatal health information is feasible, but the national health information systems need improvements to fill gaps. To improve international comparisons, stillbirth definitions should be standardised and a short list of causes of fetal and infant deaths should be developed.
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Affiliation(s)
- Mika Gissler
- National Institute for Health and Welfare, Helsinki, Finland.
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Beck S, Wojdyla D, Say L, Betran AP, Merialdi M, Requejo JH, Rubens C, Menon R, Van Look PFA. The worldwide incidence of preterm birth: a systematic review of maternal mortality and morbidity. Bull World Health Organ 2009; 88:31-8. [PMID: 20428351 DOI: 10.2471/blt.08.062554] [Citation(s) in RCA: 1274] [Impact Index Per Article: 84.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Revised: 04/18/2009] [Accepted: 04/18/2009] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To analyse preterm birth rates worldwide to assess the incidence of this public health problem, map the regional distribution of preterm births and gain insight into existing assessment strategies. METHODS Data on preterm birth rates worldwide were extracted during a previous systematic review of published and unpublished data on maternal mortality and morbidity reported between 1997 and 2002. Those data were supplemented through a complementary search covering the period 2003-2007. Region-specific multiple regression models were used to estimate the preterm birth rates for countries with no data. FINDINGS We estimated that in 2005, 12.9 million births, or 9.6% of all births worldwide, were preterm. Approximately 11 million (85%) of these preterm births were concentrated in Africa and Asia, while about 0.5 million occurred in each of Europe and North America (excluding Mexico) and 0.9 million in Latin America and the Caribbean. The highest rates of preterm birth were in Africa and North America (11.9% and 10.6% of all births, respectively), and the lowest were in Europe (6.2%). CONCLUSION Preterm birth is an important perinatal health problem across the globe. Developing countries, especially those in Africa and southern Asia, incur the highest burden in terms of absolute numbers, although a high rate is also observed in North America. A better understanding of the causes of preterm birth and improved estimates of the incidence of preterm birth at the country level are needed to improve access to effective obstetric and neonatal care.
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Affiliation(s)
- Stacy Beck
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, USA
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Abstract
OBJECTIVES Infant mortality is a major indicator of the health of a nation. We analyzed recent patterns and trends in U.S. infant mortality, with an emphasis on two of the greatest challenges: (1) persistent racial and ethnic disparities and (2) the impact of preterm and low birthweight delivery. METHODS Data from the national linked birth/infant death datasets were used to compute infant mortality rates per 100,000 live births by cause of death (COD), and per 1,000 live births for all other variables. Infant mortality rates and other measures of infant health were analyzed and compared. Leading and preterm-related CODs, and international comparisons of infant mortality rates were also examined. RESULTS Despite the rapid decline in infant mortality during the 20th century, the U.S. infant mortality rate did not decline from 2000 to 2005, and declined only marginally in 2006. Racial and ethnic disparities in infant mortality have persisted and increased, as have the percentages of preterm and low birthweight deliveries. After decades of improvement, the infant mortality rate for very low birthweight infants remained unchanged from 2000 to 2005. Infant mortality rates from congenital malformations and sudden infant death syndrome declined; however, rates for preterm-related CODs increased. The U.S. international ranking in infant mortality fell from 12th place in 1960 to 30th place in 2005. CONCLUSIONS Infant mortality is a complex and multifactorial problem that has proved resistant to intervention efforts. Continued increases in preterm and low birthweight delivery present major challenges to further improvement in the infant mortality rate.
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Affiliation(s)
- Marian F MacDorman
- Reproductive Statistics Branch, Division of Vital Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, 3311 Toledo Rd., Room 7318, Hyattsville, MD 20782, USA.
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Tromp M, Eskes M, Reitsma JB, Erwich JJHM, Brouwers HAA, Rijninks-van Driel GC, Bonsel GJ, Ravelli ACJ. Regional perinatal mortality differences in the Netherlands; care is the question. BMC Public Health 2009; 9:102. [PMID: 19366460 PMCID: PMC2674436 DOI: 10.1186/1471-2458-9-102] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2008] [Accepted: 04/14/2009] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Perinatal mortality is an important indicator of health. European comparisons of perinatal mortality show an unfavourable position for the Netherlands. Our objective was to study regional variation in perinatal mortality within the Netherlands and to identify possible explanatory factors for the found differences. METHODS Our study population comprised of all singleton births (904,003) derived from the Netherlands Perinatal Registry for the period 2000-2004. Perinatal mortality including stillbirth from 22+0 weeks gestation and early neonatal death (0-6 days) was our main outcome measure. Differences in perinatal mortality were calculated between 4 distinct geographical regions North-East-South-West. We tried to explain regional differences by adjustment for the demographic factors maternal age, parity and ethnicity and by socio-economic status and urbanisation degree using logistic modelling. In addition, regional differences in mode of delivery and risk selection were analysed as health care factors. Finally, perinatal mortality was analysed among five distinct clinical risk groups based on the mediating risk factors gestational age and congenital anomalies. RESULTS Overall perinatal mortality was 10.1 per 1,000 total births over the period 2000-2004. Perinatal mortality was elevated in the northern region (11.2 per 1,000 total births). Perinatal mortality in the eastern, western and southern region was 10.2, 10.1 and 9.6 per 1,000 total births respectively. Adjustment for demographic factors increased the perinatal mortality risk in the northern region (odds ratio 1.20, 95% CI 1.12-1.28, compared to reference western region), subsequent adjustment for socio-economic status and urbanisation explained a small part of the elevated risk (odds ratio 1.11, 95% CI 1.03-1.20). Risk group analysis showed that regional differences were absent among very preterm births (22+0 - 25+6 weeks gestation) and most prominent among births from 32+0 gestation weeks onwards and among children with severe congenital anomalies. Among term births (>or= 37+0 weeks) regional mortality differences were largest for births in women transferred from low to high risk during delivery. CONCLUSION Regional differences in perinatal mortality exist in the Netherlands. These differences could not be explained by demographic or socio-economic factors, however clinical risk group analysis showed indications for a role of health care factors.
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Affiliation(s)
- Miranda Tromp
- Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Martine Eskes
- Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Johannes B Reitsma
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Jan Jaap HM Erwich
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, Groningen, the Netherlands
| | - Hens AA Brouwers
- Department of Neonatology, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Gouke J Bonsel
- Department of Health Policy and Management, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Anita CJ Ravelli
- Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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Wuhib T, McCarthy BJ, Chorba TL, Sinitsina TA, Ivasiv IV, McNabb SJN. Underestimation of infant mortality rates in one republic of the former Soviet Union. Pediatrics 2003; 111:e596-600. [PMID: 12728116 DOI: 10.1542/peds.111.5.e596] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Kazakhstan's live-birth definition--that dates from the former Soviet Union (FSU) era--differs from that used by the World Health Organization (WHO). We studied the impacts of both live-birth definitions on the computations of the infant mortality rate (IMR) and maternal and child health (MCH) planning in Zhambyl Oblast, Kazakhstan. METHODS We interviewed caregivers and abstracted medical records to obtain birth weight and age-at-death information on infant deaths in Zhambyl Oblast from November 1, 1996, through October 31, 1997. Using the 2 indicators of birth weight and age at death, we created a matrix delineating the respective contribution to infant death (maternal health, newborn care, or infant care) for the cells. We then calculated the IMR, birth weight-specific IMR (BWS-IMR), and birth weight-proportionate IMR (BWP-IMR) for each cell. RESULTS The observed IMR in Zhambyl Oblast, in 1996--using the definition of a live birth from the FSU--was 32 per 1000 live births. The recalculated IMR--using the WHO definition--was 58.7 per 1000 live births. Computed estimates of the contribution to infant death, by the categories of maternal health, newborn care, and infant care, were 10%, 23%, and 67%, respectively, when using the live-birth definition from the Soviet era. These estimates shifted to 24%, 41%, and 35%, respectively, when using the WHO definition, yet only 8% of the Zhambyl Oblast MCH budget was earmarked to maternal health and newborn care, which we estimated accounted for 65% of infant deaths. CONCLUSIONS The live-birth definition commonly used in the FSU underestimated the IMR and undervalued the contributions to infant death by both maternal health and newborn care. We recommend that all republics of the FSU adopt the WHO live-birth definition so that the IMR can serve as a better indicator for MCH planning.
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Affiliation(s)
- Tadesse Wuhib
- Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA
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