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Warland J, Pollock D, Collier A, Horey D, Boyle F. Parents' descriptions of labouring with an antepartum fetal death: Findings from the Birthing in Grief study. Aust N Z J Obstet Gynaecol 2024; 64:133-140. [PMID: 37833833 DOI: 10.1111/ajo.13759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Evidence to guide intrapartum care when an unborn baby has died is limited. AIMS To explore parents' experiences of care during labour of an antepartum stillbirth. MATERIALS AND METHODS Semi-structured interviews with 18 bereaved parents from across Australia. Content analysis was conducted. FINDINGS Two broad themes were identified: 'explaining every step' and 'helping us feel like parents.' Sub-themes under the first broad theme, 'explaining every step', were 'how and when information was given' and 'what happens next.' 'Like any other parent', 'feeling the pain' and 'everything is clouded' were sub-themes of the second broad theme. These findings mapped to current Australian clinical practice guidelines for bereavement care around stillbirth and neonatal death, ie good communication, recognition of parenthood, shared decision making and effective support. CONCLUSIONS This study on parents' experiences of labour with a fetal death in utero brings an important perspective to intrapartum care for this group. As far as we are aware, this study is the first to focus solely on this aspect of care. Our findings could be readily mapped to the four perinatal bereavement care goals. Parents wanted care providers to facilitate their choices, their sense of control, their autonomy and their agency. They wanted to feel that they had received the 'best' care available.
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Affiliation(s)
- Jane Warland
- UniSA Clinical and Health Sciences, UniSA, Adelaide, South Australia, Australia
| | - Danielle Pollock
- Evidence-Based Healthcare Research Division, JBI, Adelaide, South Australia, Australia
| | | | - Dell Horey
- Faculty of Science Agriculture Business and Law, University of New England, Armidale, New South Wales, Australia
| | - Frances Boyle
- Institute for Social Science Research, University of Queensland, Brisbane, Queensland, Australia
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Parry M, Torvaldsen S, Nippita TA, Bowen J, Morris JM, Ibiebele I. Trends in early gestation stillbirths and neonatal deaths in New South Wales, Australia 2002-2019. Aust N Z J Obstet Gynaecol 2023; 63:541-549. [PMID: 37062902 DOI: 10.1111/ajo.13685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
BACKGROUND Little research has focused on understanding trends in early gestation (20-27 weeks) stillbirths and neonatal deaths. AIMS To examine trends in early gestation stillbirths and neonatal deaths in New South Wales (NSW), Australia. MATERIALS AND METHODS Population-based cohort study of all births ≥20 weeks gestation among female NSW residents during 2002 to 2019, induced pregnancy terminations excluded. Stillbirth rates by gestational age and birth year were calculated per 1000 fetuses-at-risk (FAR). Neonatal death rates by gestational age and birth year were calculated per 1000 live births. Linear regression was used to examine trends in stillbirth and neonatal death rates among all, singleton and twin births. RESULTS Declining trends in early gestation stillbirth and neonatal death rates were found. Stillbirth rates decreased from 1.9 and 0.9/1000 FAR in 2002 to 1.6 and 0.7 in 2019 for 20-23 and 24-27 week groups, respectively. Neonatal rates decreased from 940 and 315/1000 live births in 2002 to 925 and 189 in 2019 for the 20-23 and 24-27 week groups, respectively. Among singleton births, declining trends in stillbirth and neonatal death rates across all age groups were observed, except for 37-38 week stillbirths. No trends in twin stillbirth rates were found across gestational age groups, although a decreasing trend was observed for 20-23 week twin neonatal deaths. CONCLUSIONS Trends in early gestation stillbirth and neonatal deaths have declined in recent decades in NSW but further efforts are needed to reduce both early and late gestation stillbirth rates among twin births.
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Affiliation(s)
- Marissa Parry
- Faculty of Medicine and Health, Reproduction and Perinatal Centre, Women and Babies Research, The University of Sydney, Sydney, New South Wales, Australia
- NSW Biostatistics Training Program, NSW Ministry of Health, Sydney, New South Wales, Australia
- Northern Sydney Local Health District, Kolling Institute, Sydney, New South Wales, Australia
| | - Siranda Torvaldsen
- Faculty of Medicine and Health, Reproduction and Perinatal Centre, Women and Babies Research, The University of Sydney, Sydney, New South Wales, Australia
- Northern Sydney Local Health District, Kolling Institute, Sydney, New South Wales, Australia
- School of Population Health, UNSW, Sydney, New South Wales, Australia
| | - Tanya A Nippita
- Faculty of Medicine and Health, Reproduction and Perinatal Centre, Women and Babies Research, The University of Sydney, Sydney, New South Wales, Australia
- Northern Sydney Local Health District, Kolling Institute, Sydney, New South Wales, Australia
- Department of Obstetrics and Gynaecology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Jennifer Bowen
- Faculty of Medicine and Health, Reproduction and Perinatal Centre, Women and Babies Research, The University of Sydney, Sydney, New South Wales, Australia
- Northern Sydney Local Health District, Kolling Institute, Sydney, New South Wales, Australia
- Department of Neonatology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Jonathan M Morris
- Faculty of Medicine and Health, Reproduction and Perinatal Centre, Women and Babies Research, The University of Sydney, Sydney, New South Wales, Australia
- Northern Sydney Local Health District, Kolling Institute, Sydney, New South Wales, Australia
- Department of Obstetrics and Gynaecology, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Clinical Excellence Commission, New South Wales Ministry of Health, Sydney, New South Wales, Australia
| | - Ibinabo Ibiebele
- Faculty of Medicine and Health, Reproduction and Perinatal Centre, Women and Babies Research, The University of Sydney, Sydney, New South Wales, Australia
- Northern Sydney Local Health District, Kolling Institute, Sydney, New South Wales, Australia
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Abstract
INTRODUCTION The creatine kinase circuit is central to the regulation of high-energy phosphate metabolism and the maintenance of cellular energy turnover. This circuit is fuelled by creatine, an amino acid derivative that can be obtained from a diet containing animal products, and by synthesis in the body de novo. A recent retrospective study conducted in a cohort of 287 pregnant women determined that maternal excreted levels of creatine may be associated with fetal growth. This prospective study aims to overcome some of the limitations associated with the previous study and thoroughly characterise creatine homeostasis throughout gestation in a low-risk pregnant population. METHODS AND ANALYSIS This study is recruiting women with a singleton low-risk pregnancy who are attending Monash Health, in Melbourne, Australia. Maternal blood and urine samples, along with dietary surveys, are collected at five time points during pregnancy and then at delivery. Cord blood and placenta (including membranes and cord) are collected at birth. A biobank of tissue samples for future research is being established. Primary outcome measures will include creatine, creatine kinase and associated metabolites in antenatal bloods and urine, cord bloods and placenta, along with molecular analysis of the creatine transporter (SLC6A8) and synthesising enzymes L - arginine:glycine amidinotransferase (AGAT) and guanidinoacetate methyltransferase (GAMT) in placental tissues. Secondary outcome measures include dietary protein intake over pregnancy and any associations with maternal creatine, pregnancy events and birth outcomes. ETHICS AND DISSEMINATION Ethical approval was granted in August 2015 from Monash Health (Ref: 14140B) and Monash University (Ref: 7785). Study outcomes will be disseminated at international conferences and published in peer-reviewed scientific journals. TRIAL REGISTRATION NUMBER ACTRN12618001558213; Pre-results.
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Affiliation(s)
- Deborah L De Guingand
- The Ritchie Centre, Hudson Institute of Medical Research and Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Stacey J Ellery
- The Ritchie Centre, Hudson Institute of Medical Research and Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Miranda L Davies-Tuck
- The Ritchie Centre, Hudson Institute of Medical Research and Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Hayley Dickinson
- The Ritchie Centre, Hudson Institute of Medical Research and Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
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Davies-Tuck ML, Davey MA, Wallace EM. Maternal region of birth and stillbirth in Victoria, Australia 2000-2011: A retrospective cohort study of Victorian perinatal data. PLoS One 2017; 12:e0178727. [PMID: 28586367 PMCID: PMC5460852 DOI: 10.1371/journal.pone.0178727] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 05/17/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND There is growing evidence from high-income countries that maternal country of birth is a risk factor for stillbirth. We aimed to examine the association between maternal region of birth and stillbirth between 2000 and 2011 inclusive in Victoria, Australia. METHODS Retrospective population based cohort study of all singleton births at 24 or more weeks gestational age from 2000-2011 in Victoria, Australia. Stillbirths due to termination of pregnancy, babies with congenital anomalies and Indigenous mothers were excluded. Main Outcome Measure: Stillbirth. RESULTS Over the 12-year period there were 685,869 singleton births and 2299 stillbirths, giving an overall stillbirth rate of 3·4 per 1000 births. After adjustment for risk factors, compared to women born in Australia/New Zealand, women born in South Asia (aOR 1.27, 95% CI 1.01-1.53, p = 0.01), were more likely to have a stillbirth whereas women born in South East and East Asia were (aOR 0.60, (95% CI 0.49-0.72, p<0.001) less likely to have a stillbirth. Additionally, the increasing rate of stillbirth as gestation length progressed began to rise earlier and more steeply in the South Asian compared to Australian/New Zealand born women. The following risk factors were also significantly associated with an increased odds of stillbirth in multivariate analyses: maternal age <20 and 35 years and more, nulliparity, low socio-economic status, previous stillbirth, no ultrasound reported in 1st trimester, pre-existing hypertension, antepartum haemorrhage and failure to detect growth restriction antenatally. CONCLUSION Maternal region of birth is an independent risk factor for stillbirth. Improvements in the rate of stillbirth, particularly late pregnancy stillbirth, are likely to be gained in high-income settings where clinical care is informed by maternal region of birth.
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Affiliation(s)
- Miranda L. Davies-Tuck
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Melbourne, Victoria, Australia
| | - Mary-Ann Davey
- Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Clayton, Melbourne, Victoria, Australia
| | - Euan M. Wallace
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Clayton, Melbourne, Victoria, Australia
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