Lack of evidence for effects of lockdowns on stillbirth rates during the SARS-CoV-2 pandemic in Bavaria: analysis of the Bavarian perinatal survey from 2010 to 2020

BACKGROUND

Internationally, potential effects of national SARS-CoV-2-related lockdowns on stillbirth rates have been reported, but data for Germany, including risk factors for fetal pregnancy outcome, are lacking. The aim of this study is to compare the stillbirth rates during the two first lockdown periods in 2020 with previous years from 2010 to 2019 in a large Bavarian cohort.

METHODS

This study is a secondary analysis of the Bavarian perinatal data from 2010 to 2020, including 349,245 births. Univariate and multivariable regression analyses were performed to investigate the effect of two Bavarian lockdowns on the stillbirth rate in 2020 compared to the corresponding periods from 2010 to 2019.

RESULTS

During the first lockdown, the stillbirth rate was significantly higher compared to the reference period (4.04 vs. 3.03 stillbirths per 1000 births; P = 0.03). After adjustment for seasonal and long-term trends, this effect can no longer be observed (P = 0.2). During the second lockdown, the stillbirth rate did not differ in univariate (3.46 vs. 2.93 stillbirths per 1000 births; P = 0.22) as well as in multivariable analyses (P = 0.68), compared to the years 2010 to 2019.

CONCLUSION

After adjustment for known long-term effects, in this study we did not find evidence that the two Bavarian lockdowns had an effect on the rate of stillbirths.

A qualitative focus group study concerning perceptions and experiences of Nigerian mothers on stillbirths

Objective

To explore the experiences and perceptions of stillbirth among mothers from a tertiary medical centre in Kano, Northern Nigeria.

Design

Qualitative, interpretative.

Setting

Tertiary healthcare facility, Murtala Muhammad Specialist Hospital (MMSH), Kano, Northern Nigeria.

Sample

Mothers who had given birth to a liveborn baby at the MMSH in the prior 6 months (n = 31). In order to capture the experiences and perception of stillbirth within this cohort we approached mothers who had in a previous pregnancy experienced a stillbirth. Of the 31 who attended 16 had a previous stillbirth.

Methods

Semi-structured Focus Group Discussions, consisting of open-ended questions about stillbirth, beliefs, experiences and influences were held in MMSH, conducted over 1 day.

Results

Our findings highlight that this is a resource-poor tertiary facility serving an ever-growing population, increasing strain on the hospital and healthcare workers. Many of the participants highlighted needing permission from certain family members before accessing healthcare or medical treatment. We identified that mothers generally have knowledge on self-care during pregnancy, yet certain societal factors prevented that from being their priority. Judgement and blame was a common theme, yet a complex area entwined with traditions, superstitions and the pressure to procreate with many mothers described being made to feel useless and worthless if they did not birth a live baby.

Conclusions

As access to healthcare becomes easier, there are certain traditions, family and social dynamics and beliefs which conflict with scientific knowledge and act as a major barrier to uptake of healthcare services. The findings highlight the need for investment in maternity care, appropriate health education and public enlightenment; they will help inform appropriate interventions aimed at reducing stigma around stillbirth and aide in educating mothers about the importance of appropriate health seeking behaviour. Stillbirths are occurring in this area of the world unnecessarily, globally there has been extensive research conducted on stillbirth prevention. This research has highlighted some of the areas which can be tackled by modifying existing successful interventions to work towards reducing preventable stillbirths.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-021-04207-4.

Production losses five months after outbreak with a recombinant of two PRRSV vaccine strains in 13 Danish sow herds

Background

In July 2019, a PRRSV-negative boar station was infected with a recombinant of two PRRSV vaccine strains, which subsequently spread to at least 36 herds that had received semen from the boar station. In the following months, all the infected herds reported reduced productivity. The aim of the present study was to evaluate the impact of the PRRS outbreak.

Results

Production data were collected from 13 of the herds. The average levels of farrowings/week, liveborns/litter, stillborns/litter, pre-weaning mortality and weaned pigs/litter were compared for the five-month period after infection and the preceding 7 months before infection with the new variant of PRRSV-1. Twelve herds experienced a decrease in farrowings/week (0.1-10.8% fewer farrowings/week), and all herds experienced fewer liveborns (0.8-4.8 fewer liveborns/litter) and more stillborns (0.6-2.6 more stillborns/litter). Pre-weaning mortality nearly doubled in half of the herds. Overall, the 13 herds were missing 2.4-6.5 pigs/litter at weaning during the 5 months after infection compared to the seven preceding months before infection.

Conclusion

In this study, the impact of this new PRRSV-1 variant on productivity exceeded that typically seen in Danish herds infected with PRRSV-1.

Association between sow and piglet blood hemoglobin concentrations and stillbirth risk

Previous studies have indicated that high piglet blood hemoglobin concentration (HbC) at birth lead to better performance later in life. The primary objective of this study was to investigate the association between sow and piglet blood HbC at farrowing. A secondary objective was to investigate the relationship between sow HbC and probability of stillbirths. Farrowings were observed in 22 sows in a Danish commercial herd. Maternal blood HbC was measured 1–3 days before farrowing using a HemoCue 201 + Hb device. Similarly, HbC was measured from 144 offspring piglets before colostrum intake. Total number of born piglets per litter and parity of the sow were recorded and stillborn piglets were identified using a lung flotation technique. The association between HbC in sows and piglets was determined using a linear mixed model. The relationship between sow HbC and probability of stillbirths was determined using a generalized linear model. The mean HbC of the sows and piglets were 106.9 ± 12.2 and 124.4 ± 19.9 g/L, respectively. A tendency towards a positive association between HbC of the piglets and HbC of the sow around farrowing was found (P = 0.058). Additionally, the probability of stillbirths was negatively associated with the sow HbC (P = 0.021). These results indicate that HbC in newborn piglets may be increased by increasing the sow HbC. Furthermore, stillbirth rates might be reduced by increasing the HbC of the sow.

Tongue development in stillborns autopsied at different gestational ages

OBJECTIVES

This study aimed to analyze, through the morphometric method, the perimeter and length of the tongue, the collagen fibers, and the perimeter of blood vessels at different gestational ages and fetal weights.

MATERIAL AND METHODS

Tongues (n=55) of stillborns autopsied at 23-40 weeks of gestational age were macroscopically analyzed, and their length and perimeter were measured. Fifty-five tongue fragments were collected through a longitudinal section in the region that accompanies the median lingual sulcus and histologically processed. Slides were stained with picrosirius and immunolabeled with CD31 antibody. Quantification was performed on collagen fibers under polarized light, and on the perimeter of vessels with the CD31.

RESULTS

A positive and significant correlation of gestational age with tongue perimeter and length was found. There was a positive and significant correlation between collagen fibers and gestational age, as well as between gestational age and the perimeter of blood vessels. Between collagen fibers and fetal weight, a positive and significant increase was observed. Regarding the correlation between the perimeter of blood vessels and the fetal weight, an increase was observed.

CONCLUSION

As gestational age advances, there is an increase in tongue perimeter and length, in the percentage of collagen fibers, and in vascular perimeter, demonstrating that tongue formation is directly related to tongue growth and development.

Perinatal immuno/inflammatory responses in the presence or absence of bovine fetal infection

Background

It is known that the bovine fetus can mount an immune and inflammatory reaction to infection, but it is not known whether there is a contemporaneous maternal response. Nor is it known whether the response of calves which die perinatally, with or without infection, differs from that of live perinates. Hence, the objective of this study was to determine if acute phase reactant and immunoglobulin concentrations differed between calves (and their dams) in three groups: live calves (CC; n = 21) and dead calves with (PM INF+; n = 22) or without (PM INF-; n = 89) in utero infection. In calf plasma, serum amyloid A, haptoglobin, immunoglobulins M, G₁ and G₂ and interleukin-6 were measured. In dam serum, SAA and Hp was measured and in amniotic and abomasal fluid, IL-6 was measured.

Results

Live calves had higher plasma concentrations of SAA and IL-6 than dead calves with (PM INF+) or without (PM INF-) in utero infection. Calves in the PM INF-, but not PM INF+ group, had higher Hp concentrations than calves in the CC group. Calves in the PM INF+ group had higher IgG₁ concentrations than calves in the PM INF- and CC groups. Except for higher IgG₁ and IgG₂ concentrations, biomarker values did not differ significantly between dead calves with or without in utero infection. Live calves had higher IL-6 concentrations in abomasal fluid compared to PM INF- calves. There were no significant differences in blood biomarker concentrations between dams of the three groups of calves. Amniotic fluid IL-6 concentrations were higher from the dams of control calves than the dams of uninfected calves.

Conclusions

Differences in biomarkers (higher Hp and IgG₁; lower SAA and IL-6) between perinatal mortalities and live perinates probably reflect differences between these two groups in age at sampling (SAA and IL-6) and in utero infection (IgG₁). Out of the six analytes measured in calves, only IgG₁ and IgG₂ were biomarkers of (chronic) in utero infection.

Forensic Aspects of Perinatal Deaths

From a forensic pathologist's perspective, there are several aspects of the perinatal postmortem that are particularly important. If a fetus is found abandoned, the pathologist needs to ascertain the fetal age, the appropriateness of growth, if the baby was born alive or dead, and the possible causes of death. In cases of litigation for perinatal deaths occurring in hospitals, access to the obstetric and neonatal notes (if the baby is born alive and dies a few hours or days later) is fundamental to reach a correct interpretation and conclusion. The most important points to consider in cases of intrapartum death are the roles of asphyxia and trauma in the causation of the baby's death. Timing of the fetal death in relation to delivery may also be an important point in these cases. Finally, intrapartum lesions should always be considered in the differential diagnosis of possible child abuse in babies aged two months or less.

Risk factors associated with the different categories of piglet perinatal mortality in French farms

We aimed to identify mortality patterns and to establish risk factors associated with different categories of piglet perinatal mortality in French farms. At farm level, the analyses were performed on data from 146 farms that experienced perinatal mortality problems. At piglet level, the analyses were performed on data from 155 farms (7761 piglets). All data were collected over a period of 10 years (2004-14) by a consulting company, using a non-probability sampling at farm level and a random sampling at sow level. Six main categories of mortality, determined by standardised necropsy procedure, represented 84.5% of all the perinatal deaths recorded. These six categories were, in order of significance: Death during farrowing, Non- viable, Early sepsis, Mummified, Crushing and Starvation. At farm level, the percentage of deaths due to starvation was positively correlated to the percentage of deaths due to crushing and the percentage of deaths during farrowing (r>0.30, P<0.05) .The percentage of deaths due to crushing was negatively correlated to the percentage of deaths due to early sepsis (r<-0.30, P<0.05) and positively correlated to the deaths due to acute disease (r>0.30, P<0.05). Patterns of perinatal mortality at farm level were identified using a principal component analysis. Based on these, the farms could be classified, using ascending hierarchical classification, into three different clusters, highlighting issues that underlie farm differences. Risk factors were compared at piglet level for the different categories of death. Compared to other categories of death, deaths during farrowing were significantly fewer during the night than during the day. Compared to other categories of death, the likelihood of non-viable piglets tended to be higher in summer than other seasons. A smaller number of deaths in the litter was also identified for the piglets classified as non-viable or mummified. For the six main categories of perinatal mortality, the piglets which died from a specific category tended to have more littermates which died from the same category. Parity and litter size also had more significant effects on certain categories of death compared to others. The study provides novel information on the risk factors associated with specific categories of piglet perinatal mortality. The classification of farms into the 3 different clusters could lead to a more targeted management of perinatal mortality on individual farms.

Prevalence of constipation and its influence on post-parturient disorders in tropical sows

The present study aimed to investigate the prevalence of constipation and its influence on farrowing duration and the evidence of post-parturient disorders in tropical sows and to evaluate the efficacy of a laxative supplementation during gestation and around farrowing on the incidence of constipation. Two experiments were performed in a commercial swine herd in Thailand. In experiment 1, the prevalence of constipation was determined in 96 gestating sows. Subsequently, 62 of them (64.6 %), with a severe to moderate degree of constipation, received 20 ml of a laxative for 3 days during gestation. In experiment 2, constipation score was determined in sows before, during, and after farrowing. A total of 98 sows were randomly allocated to one of two groups: the treatment group (n = 48) received 20 ml of a laxative for 3 days before farrowing, and the control group (n = 50) did not receive any laxative. Rectal temperature, appetite score, incidence of postpartum dysgalactia syndrome (PDS), and vaginal discharge score was determined for 4 days. In experiment 1, supplementation of laxative reduced the proportion of sows with moderate to severe constipation (P < 0.05). In experiment 2, sows with moderate to very severe constipation had a 28-min longer duration of farrowing than sows with normal faeces. Constipation in sows on the day of farrowing resulted in reduced appetite on day 1 postpartum (P = 0.008). The incidence of sows with fever on day 1 postpartum was two times higher in sows with constipation than in sows with normal faeces (36.2 and 16.7 %, respectively; P = 0.041).

Post-mortem findings and piglet mortality in relation to strategic use of straw at farrowing

Piglet survival is the outcome of complex interactions between the sow, the piglet and their environment. In order to facilitate nest-building and to provide a suitable environment for the newborn piglets, a strategic method to supply loose housed sows with large quantities of straw at farrowing has been developed by Swedish piglet-producing farmers. The objectives of this cohort study were to use post-mortem findings to assess the causes of death and to quantify the effect of a large quantity of straw provided before farrowing compared to limited small daily amounts on stillbirths, post-mortem findings in piglets dying within 5 days after birth and the pre-weaning mortality. On each of four commercial piglet-producing farms in South-West Sweden, one batch of sows was studied during two consecutive lactations. At inclusion, sows were randomly assigned to two treatment groups, and sows remaining in the batch during the next lactation switched treatment group. In the STRAW group (n=181 litters) sows were provided with 15-20 kg of chopped straw 2 days prior to the calculated date of farrowing. Sows in the CONTROL group (n=182 litters) received 0.5-1 kg of chopped straw on a daily basis plus about 2 kg for nest-building when the stockperson judged the sow to be about to farrow. After onset of farrowing, additionally 1-2 kg was given. Post-mortem examination was performed in all piglets that died within 5 days after birth (n=798). The three major post-mortem findings were starvation (34%) crushing by the sow (28%), and enteritis (24%). In conclusion, strategic use of large quantities of straw reduced the number of stillborn piglets per litter by 27% (p=0.007). Under the conditions studied, the pre-weaning mortality of liveborn piglets was not affected by treatment; however, the distribution of post-mortem findings differed with fewer piglets dying due to starvation and more due to crushing and enteritis in STRAW litters.

A Unique Case of Eosinophilic Pancreatitis and Anencephaly in the Fetus of a Type I Diabetic Mother

Pancreatic infiltration with eosinophils is an uncommon finding with numerous etiologies. While two rare cases of eosinophilic pancreatitis in infants born to Type I diabetic mothers have been reported once in the English literature and once in the French literature, we present the additional finding of anencephaly in a 34 week old fetus. Although the pancreas was grossly unremarkable, histological inspection demonstrated an eosinophilic infiltrate in the fibrous septae and islets of Langerhans along with hypertrophy and hyperplasia of the pancreatic islets.