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Huang Y, Fan W, Xie X, Yao D. Clinical analysis of 126 cases of stillbirth in high-altitude areas. BMC Pregnancy Childbirth 2025; 25:576. [PMID: 40380311 PMCID: PMC12084980 DOI: 10.1186/s12884-025-07670-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2024] [Accepted: 04/29/2025] [Indexed: 05/19/2025] Open
Abstract
OBJECTIVE This study aims to analyze the clinical characteristics of stillbirths in high-altitude areas, strengthen monitoring of high-risk pregnant women, improve maternal health care levels, and reduce perinatal mortality rates. METHODS A retrospective collection of 126 cases of stillbirth in Nyingchi People's Hospital from 2015 to 2021 was divided into an pre-stage group (2015-2019,87 cases) and a post-stage group (2020-2021,39 cases). The incidence of stillbirth and clinical characteristics were compared between the two groups. The cases were classified into maternal factors, fetal factors, placenta/membrane/umbilical cord factors, and unknown causes, and the clinical characteristics and possible etiologies of different gestational ages and antenatal examination situations were analyzed. RESULT The overall incidence of stillbirth in the high-altitude area of this study was 2.36%, with2.07% in the pre-stage group and 3.43% in the post-stage group. There were significant differences between the two groups in gestational age and antenatal examination situation (P = 0.003 and 0.008). The main causes of stillbirth were maternal factors (45.28%), followed by placenta/membrane and umbilical cord factors (28.30%), unknown causes (17.61%), and fetal factors (8.81%). The main causes of stillbirth include hypertensive disorder complicating pregnancy, premature rupture of membranes, severe anemia, and fetal malformatiohypertensive disorder complicating pregnancyns. CONCLUSION This study provides new insights into the prevention and management of stillbirths in high-altitude areas, particularly in terms of maternal factors such as gestational hypertension and severe anemia, by analyzing the clinical characteristics and influencing factors of 126 cases of stillbirths in high-altitude areas. Therefore, this study suggests strengthening prenatal and antenatal health care management to reduce the risk of stillbirth, improve pregnancy outcomes, and promote maternal and child health.
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Affiliation(s)
- Yunbo Huang
- Department of Obstetrics, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Weijie Fan
- Department of Obstetrics and Gynaecology, Linzhi People's Hospital, Xizang, China
| | - Xinxin Xie
- Department of Obstetrics and Gynaecology, Linzhi People's Hospital, Xizang, China
| | - Donghua Yao
- Department of Obstetrics and Gynaecology, Linzhi People's Hospital, Xizang, China.
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Jamshidi Kerachi A, Shahlaee MA, Habibi P, Dehdari Ebrahimi N, Ala M, Sadeghi A. Global and regional incidence of intrahepatic cholestasis of pregnancy: a systematic review and meta-analysis. BMC Med 2025; 23:129. [PMID: 40022113 PMCID: PMC11871686 DOI: 10.1186/s12916-025-03935-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 02/07/2025] [Indexed: 03/03/2025] Open
Abstract
BACKGROUND Intrahepatic cholestasis of pregnancy (ICP) can be a source of significant distress for both pregnant women and the fetus, impairing the quality of life and well-being of pregnant women, leading to psychological disorders among pregnant women with severe or recurrent ICP, and causing life-threatening complications among fetuses. Regrettably, our current understanding of ICP globally is limited, lacking a comprehensive estimation of its incidence. Therefore, in this systematic review and meta-analysis, we aimed to investigate the global and regional incidence of ICP and identify factors that account for its variety across studies. METHODS A comprehensive search strategy was implemented across PubMed, Scopus, and Web of Science databases. To stabilize the variance, the Freeman-Tukey double arcsine transformation was employed. Subgroup analyses were conducted based on continent, publication type, study design and timing, regional classifications, developmental status, and World Bank income grouping. A multivariate meta-regression analysis was performed to estimate the effects of the continuous moderators on the effect size. RESULTS A total of 42,972,872 pregnant women were analyzed from 302 studies. The overall pooled incidence [95% confidence interval] of ICP was 2.9% [2.5, 3.3]. Studies with larger sample sizes tended to provide significantly lower estimates of ICP incidence: 1.6% [1.3, 2] vs 4.7% [3.9, 5.5]. Asia had the highest incidence of ICP among the continents, whereas Oceania had the lowest. Countries that were classified as developed and with higher income had a lower incidence of ICP than those classified as developing and low and middle income. CONCLUSIONS The findings of this study will provide valuable insights into the current knowledge regarding the association of the quality of public health and socioeconomic variations with the incidence of ICP on a global scale.
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Affiliation(s)
| | | | - Pardis Habibi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Niloofar Dehdari Ebrahimi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
- Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Moein Ala
- Experimental Medicine Research Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Sadeghi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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Welsh G, Ayoub A, Bilodeau-Bertrand M, Lewin A, Auger N. Stillbirth rates following the change in definition of fetal mortality in Quebec. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2025; 116:113-123. [PMID: 39251543 PMCID: PMC11870716 DOI: 10.17269/s41997-024-00930-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 07/30/2024] [Indexed: 09/11/2024]
Abstract
OBJECTIVES In 2019, Quebec changed its stillbirth definition to include fetal deaths at 20 weeks gestation or more. Previously, the criterion was a minimum birth weight of 500 g. We assessed the impact of the new definition on stillbirth rates. METHODS We conducted a retrospective study of stillbirth rates between 2010 and 2021 in Quebec. The exposure consisted of the period during the new definition versus the preceding period. We assessed how the new definition affected stillbirth rates using interrupted time series regression, and compared the period during the new definition with the preceding period using prevalence differences and prevalence ratios with 95% confidence intervals (CI). We determined the extent to which fetuses at the limit of viability (under 500 g or 20‒23 weeks) accounted for any increase in rates. RESULTS Stillbirth rates went from 4.11 before the new definition to 6.76 per 1000 total births immediately after. Overall, the change in definition led to an absolute increase of 2.58 stillbirths per 1000 total births, for a prevalence ratio of 1.76 (95% CI 1.61‒1.92) compared with the preceding period. Fetal deaths due to congenital anomalies increased by 6.82 per 10,000 (95% CI 4.85‒8.78), while deaths due to pregnancy termination increased by 10.47 per 10,000 (95% CI 8.04‒12.89). Once the definition changed, 37% of stillbirths were under 500 g and 42% were between 20 and 23 weeks, with around half of these caused by congenital anomalies and terminations. CONCLUSION Stillbirth rates increased after the definition changed in Quebec, mainly due to congenital anomalies and pregnancy terminations.
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Affiliation(s)
- Golden Welsh
- Department of Demography, University of Montreal, Montreal, Quebec, Canada
- Institut national de santé publique du Québec, Montreal, Quebec, Canada
| | - Aimina Ayoub
- Institut national de santé publique du Québec, Montreal, Quebec, Canada
- University of Montreal Hospital Research Centre, Montreal, Quebec, Canada
| | | | - Antoine Lewin
- Department of Obstetrics and Gynecology, University of Sherbrooke, Sherbrooke, Quebec, Canada
- Medical Affairs and Innovation, Héma-Québec, Saint-Laurent, Quebec, Canada
| | - Nathalie Auger
- Institut national de santé publique du Québec, Montreal, Quebec, Canada.
- University of Montreal Hospital Research Centre, Montreal, Quebec, Canada.
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Quebec, Canada.
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.
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Höglund B, Hildingsson I. Is it possible for parents to endure a stillbirth? Initial experiences, perceptions and strategies: individual in-depth interviews in Sweden 2021-2023. BMC Pregnancy Childbirth 2025; 25:4. [PMID: 39754069 PMCID: PMC11699641 DOI: 10.1186/s12884-024-07055-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 12/09/2024] [Indexed: 01/06/2025] Open
Abstract
BACKGROUND Stillbirth occurs at a rate of 3.0 per thousand in Sweden. However, few studies have focused on the initial experiences of parents facing a stillbirth. The aim of this qualitative study is to deepen and broadly explore parents' initial experiences, perceptions, internal processes and strategies from the moment of suspicion or awareness of stillbirth until one month after the event. METHODS Ten individual in-depth interviews were conducted between 2021 and 2023, and data were evaluated using thematic network analysis. RESULTS Two key themes emerged: 'Following the journey - from suspicion to acceptance' and 'Support, structured activities and processes after stillbirth'. These themes captured the significant consequences of a sudden, unexpected and devastating end to pregnancy. The suspicion and eventual diagnosis of stillbirth were initially associated with sudden discomfort, fear, overwhelming grief, and intense pain. Nevertheless, a vaginal birth was regarded as the optimal mode of delivery for both physical and emotional wellbeing. Caring for the stillborn baby through physical proximity for an extended period of time helped parents comprehend and cope with their grief, while also affirming their sense of parenthood. CONCLUSIONS This study sheds light on the profound and devastating impact of stillbirth on parents who are confronted with the loss of their long-awaited and cherished baby. The intense grief and pain experienced by parents during the first month after stillbirth were described as an ongoing heavy burden, persisting day and night, and reflected in poor/very poor mental health. Despite the immense challenges faced by parents, the study highlights the importance of developing individual coping strategies to deal with this tragic and irreversible life-changing event.
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Affiliation(s)
- Berit Höglund
- Department of Women's and Children's Health, Uppsala University, Uppsala, 751 85, Sweden.
| | - Ingegerd Hildingsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, 751 85, Sweden
- Department of Nursing, Mid Sweden University, Sundsvall, Sweden
- Department of Nursing, Umeå University, Umeå, Sweden
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Budal EB, Kessler J, Eide GE, Ebbing C, Collett K. Placental pathology and neonatal morbidity: exploring the impact of gestational age at birth. BMC Pregnancy Childbirth 2024; 24:201. [PMID: 38486145 PMCID: PMC10938777 DOI: 10.1186/s12884-024-06392-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 03/04/2024] [Indexed: 03/18/2024] Open
Abstract
AIM To evaluate placental pathology in term and post-term births, investigate differences in clinical characteristics, and assess the risk of adverse neonatal outcome. METHODS This prospective observational study included 315 singleton births with gestational age (GA) > 36 weeks + 6 days meeting the local criteria for referral to placental histopathologic examination. We applied the Amsterdam criteria to classify the placentas. Births were categorized according to GA; early-term (37 weeks + 0 days to 38 weeks + 6 days), term (39 weeks + 0 days to 40 weeks + 6 days), late-term (41 weeks + 0 days to 41 weeks + 6 days), and post-term births (≥ 42 weeks + 0 days). The groups were compared regarding placental pathology findings and clinical characteristics. Adverse neonatal outcomes were defined as 5-minute Apgar score < 7, umbilical cord artery pH < 7.0, admission to the neonatal intensive care unit or intrauterine death. A composite adverse outcome included one or more adverse outcomes. The associations between placental pathology, adverse neonatal outcomes, maternal and pregnancy characteristics were evaluated by logistic regression analysis. RESULTS Late-term and post-term births exhibited significantly higher rates of histologic chorioamnionitis (HCA), fetal inflammatory response, clinical chorioamnionitis (CCA) and transfer to neonatal intensive care unit (NICU) compared to early-term and term births. HCA and maternal smoking in pregnancy were associated with adverse outcomes in an adjusted analysis. Nulliparity, CCA, emergency section and increasing GA were all significantly associated with HCA. CONCLUSIONS HCA was more prevalent in late and post-term births and was the only factor, along with maternal smoking, that was associated with adverse neonatal outcomes. Since nulliparity, CCA and GA beyond term are associated with HCA, this should alert the clinician and elicit continuous intrapartum monitoring for timely intervention.
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Affiliation(s)
- Elisabeth B Budal
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Pathology, Haukeland University Hospital, Bergen, Norway
| | - Jørg Kessler
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - Geir Egil Eide
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Western Norway University of Applied Sciences, Bergen, Norway
| | - Cathrine Ebbing
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - Karin Collett
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.
- Department of Pathology, Haukeland University Hospital, Bergen, Norway.
- Department of Pathology, Helse Bergen HF, Haukeland University Hospital, Post box 1400, Bergen, N-5021, Norway.
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Feng CS, Li SF, Ju HH. The application of the ICD-10 for antepartum stillbirth patients in a referral centre of Eastern China: a retrospective study from 2015 to 2022. BMC Pregnancy Childbirth 2024; 24:164. [PMID: 38408955 PMCID: PMC10895843 DOI: 10.1186/s12884-024-06313-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 02/01/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND The causes of some stillbirths are unclear, and additional work must be done to investigate the risk factors for stillbirths. OBJECTIVE To apply the International Classification of Disease-10 (ICD-10) for antepartum stillbirth at a referral center in eastern China. METHODS Antepartum stillbirths were grouped according to the cause of death according to the International Classification of Disease-10 (ICD-10) criteria. The main maternal condition at the time of antepartum stillbirth was assigned to each patient. RESULTS Antepartum stillbirths were mostly classified as fetal deaths of unspecified cause, antepartum hypoxia. Although more than half of the mothers were without an identified condition at the time of the antepartum stillbirth, where there was a maternal condition associated with perinatal death, maternal medical and surgical conditions and maternal complications during pregnancy were most common. Of all the stillbirths, 51.2% occurred between 28 and 37 weeks of gestation, the main causes of stillbirth at different gestational ages also differed. Autopsy and chromosomal microarray analysis (CMA) were recommended in all stillbirths, but only 3.6% received autopsy and 10.5% underwent chromosomal microarray analysis. CONCLUSIONS The ICD-10 is helpful in classifying the causes of stillbirths, but more than half of the stillbirths in our study were unexplained; therefore, additional work must be done. And the ICD-10 score may need to be improved, such as by classifying stillbirths according to gestational age. Autopsy and CMA could help determine the cause of stillbirth, but the acceptance of these methods is currently low.
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Affiliation(s)
- Chuan-Shou Feng
- Obstetrical department, Changzhou Women and Children Health Hospital, Nanjing Medical University, Changzhou, Jiangsu, China.
| | - Shu-Fen Li
- Obstetrical department, Changzhou Women and Children Health Hospital, Nanjing Medical University, Changzhou, Jiangsu, China
| | - Hui-Hui Ju
- Obstetrical department, Changzhou Women and Children Health Hospital, Nanjing Medical University, Changzhou, Jiangsu, China
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Lundén M, Hulthén Varli I, Kopp Kallner H, Åmark H. Incidence of stillbirth among women with different risk profiles in Stockholm 2001-2020: a repeated cross-sectional study. Acta Obstet Gynecol Scand 2024; 103:59-67. [PMID: 37855671 PMCID: PMC10755135 DOI: 10.1111/aogs.14695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/07/2023] [Accepted: 10/04/2023] [Indexed: 10/20/2023]
Abstract
INTRODUCTION The incidence of stillbirth in Sweden has started to decline. However, some comparable high-income countries in Europe have an even lower incidence, indicating a potential for further reduction. The aim of our study was to investigate how the incidence of stillbirth for singleton pregnancies has changed over the past two decades in the Stockholm Region in different groups of women to detect the groups at highest risk. MATERIAL AND METHODS This was a repeated cross-sectional study with data from the Stockholm Stillbirth Database and the Pregnancy Register including all cases of stillbirth in Stockholm in singleton pregnancies between 2001 and 2020, in total 1804 stillbirths. The time period was divided into four equal groups and the incidence of stillbirth was compared between the groups. RESULTS The overall incidence of stillbirth in the Stockholm Region has decreased from 3.8/1000 births in 2001-2005 to 2.9/1000 births in 2016-2020 (P-value <0.001). In most of the groups studied, the incidence decreased, but among women originating from sub-Saharan Africa the incidence significantly rose from 7.9/1000 births in 2001-2005 to 10.1/1000 births in 2016-2020 (P-value 0.025). In this group, stillbirth occurred prematurely to a higher extent and the women were more likely to be multiparous. CONCLUSIONS The incidence of stillbirth in the Stockholm Region has declined. However, among women originating from sub-Saharan Africa the incidence was significantly higher compared with women originating from other regions and it is still rising. More research is needed to understand why this group is at higher risk and how to monitor their pregnancies to decrease this risk.
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Affiliation(s)
- Minna Lundén
- Department of Clinical Sciences, Danderyd HospitalKarolinska InstituteStockholmSweden
- Department of Obstetrics and GynecologyDanderyd HospitalStockholmSweden
| | - Ingela Hulthén Varli
- Department of Women's and Children's HealthKarolinska InstituteStockholmSweden
- Department of Obstetrics and GynecologyKarolinska University HospitalStockholmSweden
| | - Helena Kopp Kallner
- Department of Clinical Sciences, Danderyd HospitalKarolinska InstituteStockholmSweden
- Department of Obstetrics and GynecologyDanderyd HospitalStockholmSweden
| | - Hanna Åmark
- Department of Clinical Sciences, Danderyd HospitalKarolinska InstituteStockholmSweden
- Department of Clinical Science and Education, Unit of Obstetrics and Gynecology, SödersjukhusetKarolinska InstituteStockholmSweden
- Department of Obstetrics and GynecologySödersjukhusetStockholmSweden
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Lindqvist PG, Gissler M, Essén B. Is there a relation between stillbirth and low levels of vitamin D in the population? A bi-national follow-up study of vitamin D fortification. BMC Pregnancy Childbirth 2023; 23:359. [PMID: 37198534 DOI: 10.1186/s12884-023-05673-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 05/03/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Stillbirth has been associated with low plasma vitamin D. Both Sweden and Finland have a high proportion of low plasma vitamin D levels (< 50 nmol/L). We aimed to assess the odds of stillbirth in relation to changes in national vitamin D fortification. METHODS We surveyed all pregnancies in Finland between 1994 and 2021 (n = 1,569,739) and Sweden (n = 2,800,730) with live or stillbirth registered in the Medical Birth Registries. The mean incidences before and after changes in the vitamin D food fortification programs in Finland (2003 and 2009) and Sweden (2018) were compared with cross-tabulation with 95% confidence intervals (CI). RESULTS In Finland, the stillbirth rate declined from ~ 4.1/1000 prior to 2003, to 3.4/1000 between 2004 and 2009 (odds ratio [OR] 0.87, 95% CI 0.81-0.93), and to 2.8/1000 after 2010 (OR 0.84, 95% CI 0.78-0.91). In Sweden, the stillbirth rate decreased from 3.9/1000 between 2008 and 2017 to 3.2/1000 after 2018 (OR 0.83, 95% CI 0.78-0.89). When the level of the dose-dependent difference in Finland in a large sample with correct temporal associations decreased, it remained steady in Sweden, and vice versa, indicating that the effect may be due to vitamin D. These are observational findings that may not be causal. CONCLUSION Each increment of vitamin D fortification was associated with a 15% drop in stillbirths on a national level. If true, and if fortification reaches the entire population, it may represent a milestone in preventing stillbirths and reducing health inequalities.
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Affiliation(s)
- Pelle G Lindqvist
- Clinical Sciences and Education, Obstetrics and Gynecology, Karolinska Institutet, Södersjukhuset, Sjukhusbacken 10, Stockholm, 11883, Sweden.
- Department of Obstetrics and Gynecology, Södersjukhuset, Stockholm, Sweden.
| | - Mika Gissler
- Department of Knowledge Brokers, THL Finnish Institute for Health and Welfare, Helsinki, Finland
- Research Centre for Child Psychiatry and Invest Research Flagship, University of Turku, Turku, Finland
- Region Stockholm, Academic Primary Health Care Centre, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Birgitta Essén
- Department of Women's and Children's Health/IMHm, Uppsala University, Uppsala, Sweden
- WHO Collaborating Centre On Migration and Health, Uppsala University, Uppsala, Sweden
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Atkins B, Blencowe H, Boyle FM, Sacks E, Horey D, Flenady V. Is care of stillborn babies and their parents respectful? Results from an international online survey. BJOG 2022; 129:1731-1739. [PMID: 35289061 DOI: 10.1111/1471-0528.17138] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 02/02/2022] [Accepted: 02/07/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To quantify parents' experiences of respectful care around stillbirth globally. DESIGN Multi-country, online, cross-sectional survey. SETTING AND POPULATION Self-identified bereaved parents (n = 3769) of stillborn babies from 44 high- and middle-income countries. METHODS Parents' perspectives of seven aspects of care quality, factors associated with respectful care and seven bereavement care practices were compared across geographical regions using descriptive statistics. Respectful care was compared between country-income groups using multivariable logistic regression. MAIN OUTCOME MEASURES Self-reported experience of care around the time of stillbirth. RESULTS A quarter (25.4%) of 3769 respondents reported disrespectful care after stillbirth and 23.5% reported disrespectful care of their baby. Gestation less than 30 weeks and primiparity were associated with disrespect. Reported respectful care was lower in middle-income countries than in high-income countries (adjusted odds ratio 0.35, 95% CI 0.29-0.42, p < 0.01). In many countries, aspects of care quality need improvement, such as ensuring families have enough time with providers. Participating respondents from Latin America and southern Europe reported lower satisfaction across all aspects of care quality compared with northern Europe. Unmet need for memory-making activities in middle-income countries was high. CONCLUSIONS Many parents experience disrespectful care around stillbirth. Provider training and system-level support to address practical barriers are urgently needed. However, some practices (which are important to parents) can be readily implemented such as memory-making activities and referring to the baby by name.
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Affiliation(s)
- Bethany Atkins
- EGA Institute for Women's Health, University College London, London, UK
| | - Hannah Blencowe
- MARCH Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Frances M Boyle
- Institute for Social Science Research, The University of Queensland, Brisbane, Queensland, Australia.,NHMRC Centre of Research Excellence, Mater Research Institute-The University of Queensland, South Brisbane, Queensland, Australia
| | - Emma Sacks
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Dell Horey
- NHMRC Centre of Research Excellence, Mater Research Institute-The University of Queensland, South Brisbane, Queensland, Australia.,Department of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Vicki Flenady
- NHMRC Centre of Research Excellence, Mater Research Institute-The University of Queensland, South Brisbane, Queensland, Australia
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Taweevisit M, Thorner PS. Placental Findings Contributing to Perinatal Death: A 15-Year Retrospective Review from a Teaching Hospital in Thailand. Fetal Pediatr Pathol 2022; 41:18-28. [PMID: 32238079 DOI: 10.1080/15513815.2020.1747121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: The placenta is infrequently examined in developing countries. This study examined the role of placental pathology in perinatal deaths at Chulalongkorn University Hospital, Bangkok. Methods: Included were singleton intrauterine deaths after gestational week 20 and live-born infants up to 1 week old, over a 15-year period. Placental lesions were classified as: inflammatory-immune, maternal stromal-vascular, fetal stromal-vascular, umbilical cord complications and other. Results: 208 such cases had the placenta available. A placental cause of death was found in 96 (46%), non-placental causes in 28% and the cause of death was unknown in 26%. Of those 96 placentas, 44% were categorized as inflammatory-immune, 30% maternal stromal-vascular, 13% fetal stromal-vascular, 7% umbilical cord complications and 6% other. Conclusions: Placental causes of death were less common than in many Western studies, but inflammatory-immune processes more common. These differences may relate to how cases were accrued, and/or local socioeconomic factors, and warrant further study.
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Affiliation(s)
- Mana Taweevisit
- Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Paul Scott Thorner
- Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
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Mendez-Figueroa H, Chen HY, Chauhan SP. Adverse Outcomes among Low-Risk Pregnancies at 39 to 41 Weeks: Stratified by Birth Weight Percentile. Am J Perinatol 2021; 38:e269-e283. [PMID: 32340043 DOI: 10.1055/s-0040-1709673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE This study aimed to assess the risk of adverse outcomes among low-risk pregnancies at 39 to 41 weeks, stratified by birth weight percentile. STUDY DESIGN This retrospective cohort study utilized the U.S. vital statistics datasets (2013-2017) and evaluated low-risk women with nonanomalous cephalic singleton gestations who labored and delivered at 39 to 41 weeks, regardless of ultimate mode of delivery. Newborns were categorized as small (<10th percentile), large (>90th percentile), or appropriate (10-90th percentile) for gestational ages (SGA, LGA, and AGA, respectively). The primary outcome, composite neonatal adverse outcome (CNAO), included Apgar's score <5 at 5 minutes, assisted ventilation >6 hours, seizure, or neonatal death. The secondary outcome, composite maternal adverse outcome (CMAO), included intensive care unit admission, blood transfusion, uterine rupture, or unplanned hysterectomy. Multivariable Poisson's regression was used to estimate the association (using adjusted relative risk [aRR] and 95% confidence interval [CI]). RESULTS Of 19.8 million live births during the study interval, approximately 8.9 million (44.9%) met the inclusion criteria, with 9.9% being SGA, 9.2% being LGA, and 80.9% being AGA. SGA newborns delivered at 40 (aRR = 1.17; 95% CI: 1.12-1.23) and at 41 weeks (aRR = 1.55; 95% CI: 1.45-1.66) had a higher risk of CNAO than at 39 weeks. Similarly, LGA newborns delivered at 40 (aRR = 1.13; 95% CI: 1.07-1.19) and 41 weeks (aRR = 1.44; 95% CI: 1.35-1.54) and AGA newborns delivered at 40 (aRR = 1.24; 95% CI: 1.21-1.26) and 41 weeks (aRR = 1.57; 95% CI: 1.53-1.61) also had a higher risk of CNAO than at 39 weeks. CMAO was also significantly higher at 40 and 41 weeks than at 39 weeks, regardless of whether the mothers delivered SGA, LGA, or AGA newborns. CONCLUSION Among low-risk pregnancies, the risks of composite neonatal and maternal adverse outcomes increase from 39 through 41 weeks' gestation, irrespective of whether newborns are SGA, LGA, or AGA.
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Affiliation(s)
- Hector Mendez-Figueroa
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Han Yang Chen
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Suneet P Chauhan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
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12
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Åmark H, Pilo C, Hulthén Varli I. Stillbirth in term and late term gestations in Stockholm during a 20-year period, incidence and causes. PLoS One 2021; 16:e0251965. [PMID: 34033674 PMCID: PMC8148351 DOI: 10.1371/journal.pone.0251965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 05/06/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction The incidence of stillbirth has decreased marginally or remained stable during the past decades in high income countries. A recent report has shown Stockholm to have a lower incidence of stillbirth at term than other parts of Sweden. The risk of antepartum stillbirth increases in late term and postterm pregnancies which is one of the factors contributing to the current discussion regarding the optimal time of induction of labor due to postterm pregnancy. Material and methods This is a cohort study based on the Stockholm Stillbirth Database which contains all cases of stillbirth from 1998-2018 in Stockholm County. All cases were reviewed systematically and the cause of death was evaluated according to the Stockholm Stillbirth Classification. Stillbirths diagnosed between gestational week (GW) 37+0 and 40+6 n = 605 were compared to stillbirths diagnosed from GW 41+0 and onwards n = 157, according to the cause of stillbirth and pregnancy and maternal characteristics. The aim was to evaluate the incidence of stillbirth over time and the incidence of stillbirth diagnosed from GW 41+0. Results In Stockholm County the overall incidence of stillbirth has decreased from 4.6/1000 births during the period 1998-2004 to 3.4/1000 births during the period 2014-2018, p-value <0.001. When comparing the same time periods, the incidence of stillbirth diagnosed from GW 41+0 and onwards has decreased from 0.5/1000 births to 0.15/1000 births, p-value <0.001. Among women still pregnant at GW 41+0 the incidence of stillbirth has decreased from 1.8/ 1000 to 0.5/ 1000. When comparing stillbirths diagnosed at GW 37+0-40+6 with stillbirths diagnosed from GW 41+0 and onwards infection was a more common cause of stillbirth in the latter group. Conclusion In Stockholm County there was a decreasing incidence of stillbirth overall and in stillbirths diagnosed from 41+0 weeks of gestation and onwards during the period 1998-2018. In stillbirths diagnosed from GW 41+0 and onwards infection was a more common cause of death compared to stillbirths diagnosed between GW 37+0 and 40+6.
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Affiliation(s)
- Hanna Åmark
- Department of Clinical Science and Education, Unit of Obstetrics and Gynecology, Karolinska Institute, Södersjukhuset, Stockholm, Sweden
- * E-mail:
| | - Christina Pilo
- Department of Obstetrics and Gynecology, Södertälje Hospital, Stockholm, Sweden
| | - Ingela Hulthén Varli
- Department of Women´s and Children´s Health, Karolinska Institutet, Stockholm, Sweden
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13
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Åmark H, Westgren M, Sirotkina M, Hulthén Varli I, Persson M, Papadogiannakis N. Maternal obesity and stillbirth at term; placental pathology-A case control study. PLoS One 2021; 16:e0250983. [PMID: 33930082 PMCID: PMC8087010 DOI: 10.1371/journal.pone.0250983] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 04/16/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The aim was to explore the potential role of the placenta for the risk of stillbirth at term in pregnancies of obese women. METHODS This was a case-control study comparing placental findings from term stillbirths with placental findings from live born infants. Cases were singleton term stillbirths to normal weight or obese women, identified in the Stockholm stillbirth database, n = 264 and n = 87, respectively. Controls were term singletons born alive to normal weight or obese women, delivered between 2002-2005 and between 2018-2019. Placentas were compared between women with stillborn and live-born infants, using logistic regression analyses. RESULTS A long and hyper coiled cord, cord thrombosis and velamentous cord insertion were stronger risk factors for stillbirth in obese women compared to normal weight women. When these variables were adjusted for in the logistic regression analysis, also adjusted for potential confounders, the odds ratio for stillbirth in obese women decreased from 1.89 (CI 1.24-2.89) to 1.63 (CI 1.04-2.56). CONCLUSION Approximately one fourth of the effect of obesity on the risk of stillbirth in term pregnancies is explained by umbilical cord associated pathology.
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Affiliation(s)
- Hanna Åmark
- Dept of Clinical Science and Education, Unit of Obstetrics and Gynecology, Karolinska Institute, Södersjukhuset, Stockholm, Sweden
- * E-mail:
| | - Magnus Westgren
- Dept of Clinical Sciences, Intervention & Technology, Karolinska Institute, Stockholm, Sweden
| | - Meeli Sirotkina
- Dep of Laboratory Medicine, Karolinska University Hospital Huddinge, Huddinge, Sweden
| | - Ingela Hulthén Varli
- Department of Women´s and Children´s Health, Karolinska Institutet, Stockholm, Sweden
| | - Martina Persson
- Dep of Medicine, Clinical Epidemiology Unit, Karolinska University Hospital, Stockholm, Sweden
- Dept of Clinical Science and Education, Unit of Pediatrics, Karolinska Institute, Södersjukhuset, Stockholm, Sweden
| | - Nikos Papadogiannakis
- Dep of Laboratory Medicine, Karolinska University Hospital Huddinge, Huddinge, Sweden
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14
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Pekkola M, Tikkanen M, Loukovaara M, Lohi J, Paavonen J, Stefanovic V. Postmortem examination protocol and systematic re-evaluation reduce the proportion of unexplained stillbirths. J Perinat Med 2020; 48:771-777. [PMID: 31990664 DOI: 10.1515/jpm-2019-0426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 12/22/2019] [Indexed: 11/15/2022]
Abstract
Background Stillbirth often remains unexplained, mostly due to a lack of any postmortem examination or one that is incomplete and misinterpreted. Methods This retrospective cohort study was conducted at the Department of Obstetrics and Gynecology, Helsinki University Hospital, Finland, and comprised 214 antepartum singleton stillbirths from 2003 to 2015. Maternal and fetal characteristics and the results of the systematic postmortem examination protocol were collected from medical records. Causes of death were divided into 10 specific categories. Re-evaluation of the postmortem examination results followed. Results Based on our systematic protocol, the cause of death was originally defined and reported as such to parents in 133 (62.1%) cases. Re-evaluation of the postmortem examination results revealed the cause of death in an additional 43 (20.1%) cases, with only 23 (10.7%) cases remaining truly unexplained. The most common cause of stillbirth was placental insufficiency in 56 (26.2%) cases. A higher proportion of stillbirths that occurred at ≥39 gestational weeks remained unexplained compared to those that occurred earlier (24.1% vs. 8.6%) (P = 0.02). Conclusion A standardized postmortem examination and a re-evaluation of the results reduced the rate of unexplained stillbirth. Better knowledge of causes of death may have a major impact on the follow-up and outcome of subsequent pregnancies. Also, closer examination and better interpretation of postmortem findings is time-consuming but well worth the effort in order to provide better counseling for the grieving parents.
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Affiliation(s)
- Maria Pekkola
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Minna Tikkanen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mikko Loukovaara
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jouko Lohi
- Department of Pathology, University of Helsinki, Helsinki, Finland
| | - Jorma Paavonen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Vedran Stefanovic
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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15
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Manjavidze T, Rylander C, Skjeldestad FE, Kazakhashvili N, Anda EE. Incidence and Causes of Perinatal Mortality in Georgia. J Epidemiol Glob Health 2020; 9:163-168. [PMID: 31529933 PMCID: PMC7310824 DOI: 10.2991/jegh.k.190818.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 08/15/2019] [Indexed: 01/16/2023] Open
Abstract
Georgia has one of the highest perinatal mortality rates (i.e., stillbirths and early neonatal deaths combined) in Europe. The Georgian Birth Registry was started in 2016 to provide data for preventive measures of maternal and child health. In this study, we aim to determine the incidence of perinatal mortality, assess the distribution of stillbirths and early neonatal deaths, and to determine the major causes of perinatal mortality in Georgia. Data sources were the Georgian Birth Registry and the vital registration system for the year 2017. Causes of early neonatal deaths were assigned into five categories, using the Wigglesworth classification with the Neonatal and Intrauterine deaths Classification according to Etiology modification. The study used descriptive statistics only, specifically counts, means, proportions, and rates, using the statistical software STATA version 15.0. (StataCorp, College Station, TX, USA). In 2017, 489 stillbirths and 238 early neonatal deaths were recorded, resulting in a perinatal mortality rate of 13.6 per 1000 births. About 80% of stillbirths had an unknown cause of death. The majority of stillbirths occurred before the start of labor (85%), and almost one-third were delivered by caesarean section (28%). Prematurity (58%) and congenital malformations (23%) were the main causes of early neonatal deaths, and 70% of early neonatal deaths occurred after the first day of life. The perinatal mortality rate in Georgia remained high in 2017. The major causes of early neonatal deaths were comparable to those of many high-income countries. Contrary to global data, most early neonatal deaths occurred after the first day of life.
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Affiliation(s)
- Tinatin Manjavidze
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø - The Arctic University of Norway, Hansine Hansens veg 18, Tromsø 9037, Norway
| | - Charlotta Rylander
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø - The Arctic University of Norway, Hansine Hansens veg 18, Tromsø 9037, Norway
| | - Finn Egil Skjeldestad
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø - The Arctic University of Norway, Hansine Hansens veg 18, Tromsø 9037, Norway
| | - Nata Kazakhashvili
- Department of Public Health, Faculty of Medicine, Ivane Javakhishvili Tbilisi State University, 1 Chavchavadze Avenue, Tbilisi 0179, Georgia
| | - Erik Eik Anda
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø - The Arctic University of Norway, Hansine Hansens veg 18, Tromsø 9037, Norway
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16
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Jaiman S, Romero R, Pacora P, Jung E, Bhatti G, Yeo L, Kim YM, Kim B, Kim CJ, Kim JS, Qureshi F, Jacques SM, Erez O, Gomez-Lopez N, Hsu CD. Disorders of placental villous maturation in fetal death. J Perinat Med 2020; 0:/j/jpme.ahead-of-print/jpm-2020-0030/jpm-2020-0030.xml. [PMID: 32238609 PMCID: PMC8262362 DOI: 10.1515/jpm-2020-0030] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 02/21/2020] [Indexed: 12/22/2022]
Abstract
Objective The aims of this study were to ascertain the frequency of disorders of villous maturation in fetal death and to also delineate other placental histopathologic lesions in fetal death. Methods This was a retrospective observational cohort study of fetal deaths occurring among women between January 2004 and January 2016 at Hutzel Women's Hospital, Detroit, MI, USA. Cases comprised fetuses with death beyond 20 weeks' gestation. Fetal deaths with congenital anomalies and multiple gestations were excluded. Controls included pregnant women without medical/obstetrical complications and delivered singleton, term (37-42 weeks) neonate with 5-min Apgar score ≥7 and birthweight between the 10th and 90th percentiles. Results Ninety-two percent (132/143) of placentas with fetal death showed placental histologic lesions. Fetal deaths were associated with (1) higher frequency of disorders of villous maturation [44.0% (64/143) vs. 1.0% (4/405), P < 0.0001, prevalence ratio, 44.6; delayed villous maturation, 22% (31/143); accelerated villous maturation, 20% (28/143); and maturation arrest, 4% (5/143)]; (2) higher frequency of maternal vascular malperfusion lesions [75.5% (108/143) vs. 35.7% (337/944), P < 0.0001, prevalence ratio, 2.1] and fetal vascular malperfusion lesions [88.1% (126/143) vs. 19.7% (186/944), P < 0.0001, prevalence ratio, 4.5]; (3) higher frequency of placental histologic patterns suggestive of hypoxia [59.0% (85/143) vs. 9.3% (82/942), P < 0.0001, prevalence ratio, 6.8]; and (4) higher frequency of chronic inflammatory lesions [53.1% (76/143) vs. 29.9% (282/944), P < 0.001, prevalence ratio 1.8]. Conclusion This study demonstrates that placentas of women with fetal death were 44 times more likely to present disorders of villous maturation compared to placentas of those with normal pregnancy. This suggests that the burden of placental disorders of villous maturation lesions is substantial.
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Affiliation(s)
- Sunil Jaiman
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Pathology, Hutzel Women’s Hospital, Wayne State University School of Medicine, Detroit, MI, USA
| | - Roberto Romero
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan, USA
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, Michigan, USA
- Detroit Medical Center, Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Florida International University, Miami, Florida, USA
| | - Percy Pacora
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Eunjung Jung
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Gaurav Bhatti
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Lami Yeo
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Yeon Mee Kim
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Pathology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Bomi Kim
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Pathology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Chong Jai Kim
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jung-Sun Kim
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Pathology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Faisal Qureshi
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Pathology, Hutzel Women’s Hospital, Wayne State University School of Medicine, Detroit, MI, USA
| | - Suzanne M. Jacques
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Pathology, Hutzel Women’s Hospital, Wayne State University School of Medicine, Detroit, MI, USA
| | - Offer Erez
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Soroka University Medical Center, School of Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Nardhy Gomez-Lopez
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
- Department of Biochemistry, Microbiology, and Immunology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Chaur-Dong Hsu
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
- Department of Physiology, Wayne State University School of Medicine, Detroit, Michigan, USA
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17
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Cnattingius S, Kramer MS, Norman M, Ludvigsson JF, Fang F, Lu D. Keep it in the family: comparing perinatal risks in small-for-gestational-age infants based on population vs within-sibling designs. Int J Epidemiol 2020; 48:297-306. [PMID: 30239740 DOI: 10.1093/ije/dyy196] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 08/15/2018] [Accepted: 08/24/2018] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Small-for-gestational-age (SGA) birth is commonly used as a proxy for fetal growth restriction, but also includes constitutionally small infants. Genetic factors account for almost half of the risk of SGA birth. We estimated perinatal risks of SGA birth using both population-based and within-sibling analyses, where the latter by design controls for shared genetic factors and maternal environmental factors that are constant across pregnancies. METHODS This was a prospective nationwide cohort study of 2 616 974 singleton infants born in Sweden between January 1987 and December 2012, of whom 1 885 924 were full siblings. We estimated associations between severe or moderate SGA (<3rd percentile and 3rd to <10th percentiles, respectively) and risks of stillbirth, neonatal mortality and morbidity, using both population-based and within-sibling analyses. Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated in stillbirth analyses, whereas relative risks (RRs) were used for analyses of neonatal outcomes. RESULTS Compared with non-SGA births (>10th percentile), the HR (95% CI) of stillbirth was 18.5 (95% CI 17.4-19.5) among severe SGA births in the population analysis and 22.5 (95% CI 18.7-27.1) in the within-sibling analysis. In non-malformed infants, RRs for neonatal mortality in moderate and severe SGA infants were similarly increased in both population and within-sibling analyses. In term non-malformed infants (≥37 weeks), SGA-related RRs of several neonatal morbidities were higher in within-sibling than in population analyses. CONCLUSIONS Perinatal risks associated with fetal growth restriction are more accurately estimated from analyses of SGA in which genetic factors are accounted for.
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Affiliation(s)
- Sven Cnattingius
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm Sweden
| | - Michael S Kramer
- Departments of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Canada
| | - Mikael Norman
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Stockholm, Sweden.,Department of Neonatalogy, Karolinska University Hospital, Stockholm, Sweden
| | - Jonas F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Pediatrics, Örebro University Hospital, Örebro, Sweden
| | - Fang Fang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Donghao Lu
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
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18
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Höglund B, Rådestad I, Hildingsson I. Few women receive a specific explanation of a stillbirth - an online survey of women's perceptions and thoughts about the cause of their baby's death. BMC Pregnancy Childbirth 2019; 19:139. [PMID: 31027483 PMCID: PMC6486682 DOI: 10.1186/s12884-019-2289-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 04/12/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Sweden, three to four out of every 1000 pregnancies end in stillbirth each year. The aim of this study was to investigate whether women who had experienced stillbirth perceived that they had received an explanation of the death and whether they believed that healthcare professionals were responsible for the death of the baby. METHODS An online survey of 356 women in Sweden who had experienced a stillbirth from January 2010 to April 2014. A mixed-methods approach with qualitative content analysis was used to examine the women's responses. RESULTS Nearly half of the women (48.6%) reported that they had not received any explanation as to why their babies had died. Of the women who reported that they had received an explanation, 84 (23.6%) had a specific explanation, and 99 (27.8%) had a vague explanation. In total, 73 (30.0%) of the 243 women who answered the question "Do you believe that healthcare personnel were responsible for the stillbirth?" stated Yes. The women reported that the healthcare staff had not acknowledged their intuition that the pregnancy was proceeding poorly. Furthermore, they perceived that the staff met them with nonchalance and arrogance. Additionally, the midwife had ignored or normalised the symptoms that could indicate that their pregnancy was proceeding poorly. Some women added that neglect and avoidance among the healthcare staff could have led to a lack of monitoring, which could have been crucial for the outcome of the pregnancy. CONCLUSIONS Half of the women surveyed reported that they had not received an explanation of their baby's death, and more than one-fourth held healthcare professionals responsible for the death.
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Affiliation(s)
- Berit Höglund
- Department of Women's and Children's Health, Uppsala University, 751 85, Uppsala, Sweden.
| | | | - Ingegerd Hildingsson
- Department of Women's and Children's Health, Uppsala University, 751 85, Uppsala, Sweden.,Department of Nursing, Mid Sweden University, Sundsvall, Sweden
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19
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Björk I, Pettersson K, Lindqvist PG. Stillbirth and factor V Leiden - A regional based prospective evaluation. Thromb Res 2019; 176:120-124. [PMID: 30825693 DOI: 10.1016/j.thromres.2019.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 02/13/2019] [Accepted: 02/20/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Approximately 10% of Swedes are carriers of coagulation factor V Leiden (FVL). It has been suggested that carriers are at an increased risk of stillbirth. We aimed to assess the risk of stillbirth in carriers of FVL as compared to non-carriers. METHODS A consecutive registration of all stillbirths from 2001 to 2015 in the whole Stockholm region has been performed. A FVL blood sample, an autopsy and histopathological examination of the placenta was scheduled to be offered all women with stillbirth. Main outcome was the difference in carriership of FVL between cases with live- vs. stillbirth. The primary cause of death was determined according to the Stockholm hierarchical classification of stillbirth. RESULTS The incidence of stillbirth was 3.6‰. Out of the 1392 cases of stillbirth occurring during the study period, FVL status was determined in 963 women. Of these 74 (7.7%) were carriers of FVL as compared to 8.1% in the control group (p = 0.6). A primary cause of death due to infection was twice as common among non-carriers compared to carriers of FVL (odds ratio [OR] = 2.3, 95% CI 1.08-4.8). In the whole study group, the prevalence of SGA was 14-fold increased among stillbirths as compared to live births (OR = 13.9, 95% CI 12.4-15.6). CONCLUSION Maternal FVL carriership was not related to an increased risk of stillbirth. However, a diagnosis of primary cause of death due to infection was less likely among FVL carriers.
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Affiliation(s)
- Ida Björk
- Departments Obstetrics and Gynecology, Sodertalje Hospital, Sodertalje, Sweden
| | - Karin Pettersson
- Karolinska University hospital, Huddinge, Sweden; Clintec, Karolinska Institutet, Huddinge, Sweden
| | - Pelle G Lindqvist
- Sodersjukhuset, Stockholm, Sweden; Clinical Sciences and Education, Sodersjukhuset, Stockholm, Sweden.
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20
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Pacora P, Romero R, Jaiman S, Erez O, Bhatti G, Panaitescu B, Benshalom-Tirosh N, Jung Jung E, Hsu CD, Hassan SS, Yeo L, Kadar N. Mechanisms of death in structurally normal stillbirths. J Perinat Med 2019; 47:222-240. [PMID: 30231013 PMCID: PMC6349478 DOI: 10.1515/jpm-2018-0216] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 07/20/2018] [Indexed: 01/05/2023]
Abstract
Objectives To investigate mechanisms of in utero death in normally formed fetuses by measuring amniotic fluid (AF) biomarkers for hypoxia (erythropoietin [EPO]), myocardial damage (cardiac troponin I [cTnI]) and brain injury (glial fibrillary acidic protein [GFAP]), correlated with risk factors for fetal death and placental histopathology. Methods This retrospective, observational cohort study included intrauterine deaths with transabdominal amniocentesis prior to induction of labor. Women with a normal pregnancy and an indicated amniocentesis at term were randomly selected as controls. AF was assayed for EPO, cTnI and GFAP using commercial immunoassays. Placental histopathology was reviewed, and CD15-immunohistochemistry was used. Analyte concentrations >90th centile for controls were considered "raised". Raised AF EPO, AF cTnI and AF GFAP concentrations were considered evidence of hypoxia, myocardial and brain injury, respectively. Results There were 60 cases and 60 controls. Hypoxia was present in 88% (53/60), myocardial damage in 70% (42/60) and brain injury in 45% (27/60) of fetal deaths. Hypoxic fetuses had evidence of myocardial injury, brain injury or both in 77% (41/53), 49% (26/53) and 13% (7/53) of cases, respectively. Histopathological evidence for placental dysfunction was found in 74% (43/58) of these cases. Conclusion Hypoxia, secondary to placental dysfunction, was found to be the mechanism of death in the majority of fetal deaths among structurally normal fetuses. Ninety-one percent of hypoxic fetal deaths sustained brain, myocardial or both brain and myocardial injuries in utero. Hypoxic myocardial injury was an attributable mechanism of death in 70% of the cases. Non-hypoxic cases may be caused by cardiac arrhythmia secondary to a cardiac conduction defect.
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Affiliation(s)
- Percy Pacora
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan
| | - Roberto Romero
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan,Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan,Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan,Center for Molecular Medicine and Genetics, Wayne State University, Detroit, Michigan
| | - Sunil Jaiman
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan
| | - Offer Erez
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan,Department of Obstetrics and Gynecology, Soroka University Medical Center, School of Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Gaurav Bhatti
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan
| | - Bogdan Panaitescu
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan
| | - Neta Benshalom-Tirosh
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan,Department of Obstetrics and Gynecology, Soroka University Medical Center, School of Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Eun Jung Jung
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan
| | - Chaur-Dong Hsu
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan
| | - Sonia S. Hassan
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan,Department of Physiology, Wayne State University School of Medicine, Detroit, Michigan
| | - Lami Yeo
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan
| | - Nicholas Kadar
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan
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Mayo JA, Lu Y, Stevenson DK, Shaw GM, Eisenberg ML. Parental age and stillbirth: a population-based cohort of nearly 10 million California deliveries from 1991 to 2011. Ann Epidemiol 2018; 31:32-37.e2. [PMID: 30642694 DOI: 10.1016/j.annepidem.2018.12.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 11/15/2018] [Accepted: 12/01/2018] [Indexed: 12/27/2022]
Abstract
PURPOSE Parental age at delivery in the United States has been rising. Advanced maternal and paternal ages have been associated with adverse pregnancy outcomes including stillbirth. However, these relationships come from studies that often do not present results for both mother and father concurrently. The purpose of this study was to estimate the risk of stillbirth for maternal and paternal age in the same cohort of deliveries. METHODS This is a population-based cohort study of all live birth and stillbirth deliveries in California from 1991 to 2011. The individual associations between maternal and paternal ages and stillbirth were estimated with hazard ratios from Cox proportional hazard models. Age was modeled continuously with restricted cubic splines to account for nonlinear relationships. Mean parental age was used as the referent group. RESULTS J-shaped associations between maternal and paternal ages were observed in crude models where older mothers and fathers had the highest hazard ratios for stillbirth. In maternal models, after adjusting for maternal and paternal covariates, young maternal age no longer showed increased hazard ratio for stillbirth, whereas the association with older mothers remained. In adjusted paternal models, the relationship between young paternal age and stillbirth was unchanged while the hazard ratio for older fathers was slightly smaller. CONCLUSIONS After adjusting for both parents' age, education, race/ethnicity, along with parity, older mothers and fathers were independently associated with elevated hazard ratios for stillbirth.
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Affiliation(s)
- Jonathan A Mayo
- March of Dimes Prematurity Research Center, Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA.
| | - Ying Lu
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA
| | - David K Stevenson
- March of Dimes Prematurity Research Center, Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Gary M Shaw
- March of Dimes Prematurity Research Center, Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Michael L Eisenberg
- Departments of Urology and Obstetrics/Gynecology, Stanford University School of Medicine, Stanford, CA
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Basu MN, Johnsen IBG, Wehberg S, Sørensen RG, Barington T, Nørgård BM. Causes of death among full term stillbirths and early neonatal deaths in the Region of Southern Denmark. J Perinat Med 2018; 46:197-202. [PMID: 28753550 DOI: 10.1515/jpm-2017-0171] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 06/19/2017] [Indexed: 11/15/2022]
Abstract
OBJECTIVE We examined the causes of death amongst full term stillbirths and early neonatal deaths. METHODS Our cohort includes women in the Region of Southern Denmark, who gave birth at full term to a stillborn infant or a neonate who died within the first 7 days from 2010 through 2014. Demographic, biometric and clinical variables were analyzed to assess the causes of death using two classification systems: causes of death and associated conditions (CODAC) and a Danish system based on initial causes of fetal death (INCODE). RESULTS A total of 95 maternal-infant cases were included. Using the CODAC and INCODE classification systems, we found that the causes of death were unknown in 59/95 (62.1%). The second most common cause of death in CODAC was congenital anomalies in 10/95 (10.5%), similar to INCODE with fetal, genetic, structural and karyotypic anomalies in 11/95 (11.6%). The majority of the mothers were healthy, primiparous, non-smokers, aged 20-34 years and with a normal body mass index (BMI). CONCLUSION Based on an unselected cohort from an entire region in Denmark, the cause of stillbirth and early neonatal deaths among full term infants remained unknown for the vast majority.
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Affiliation(s)
- Millie Nguyen Basu
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | | | - Sonja Wehberg
- Center for Clinical Epidemiology, Odense University Hospital and Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Rikke Guldberg Sørensen
- Center for Clinical Epidemiology, Odense University Hospital and Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Torben Barington
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - Bente Mertz Nørgård
- Center for Clinical Epidemiology, Odense University Hospital and Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
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Heazell AE, Stacey T, O'Brien LM, Mitchell EA, Warland J. Excessive fetal movements are a sign of fetal compromise which merits further examination. Med Hypotheses 2018; 111:19-23. [DOI: 10.1016/j.mehy.2017.12.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 12/17/2017] [Indexed: 11/30/2022]
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Alexander DA, Northcross A, Karrison T, Morhasson-Bello O, Wilson N, Atalabi OM, Dutta A, Adu D, Ibigbami T, Olamijulo J, Adepoju D, Ojengbede O, Olopade CO. Pregnancy outcomes and ethanol cook stove intervention: A randomized-controlled trial in Ibadan, Nigeria. ENVIRONMENT INTERNATIONAL 2018; 111:152-163. [PMID: 29216559 DOI: 10.1016/j.envint.2017.11.021] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 11/21/2017] [Accepted: 11/21/2017] [Indexed: 05/21/2023]
Abstract
BACKGROUND Household air pollution (HAP) exposure has been linked to adverse pregnancy outcomes. OBJECTIVES A randomized controlled trial was undertaken in Ibadan, Nigeria to determine the impact of cooking with ethanol on pregnancy outcomes. METHODS Three-hundred-twenty-four pregnant women were randomized to either the control (continued cooking using kerosene/firewood stove, n=162) or intervention group (received ethanol stove, n=162). Primary outcome variables were birthweight, preterm delivery, intrauterine growth restriction (IUGR), and occurrence of miscarriage/stillbirth. RESULTS Mean birthweights for ethanol and controls were 3076 and 2988g, respectively; the difference, 88g, (95% confidence interval: -18g to 194g), was not statistically significant (p=0.10). After adjusting for covariates, the difference reached significance (p=0.020). Rates of preterm delivery were 6.7% (ethanol) and 11.0% (control), (p=0.22). Number of miscarriages was 1(ethanol) vs. 4 (control) and stillbirths was 3 (ethanol) vs. 7 (control) (both non-significant). Average gestational age at delivery was significantly (p=0.015) higher in ethanol-users (39.2weeks) compared to controls (38.2weeks). Perinatal mortality (stillbirths and neonatal deaths) was twice as high in controls compared to ethanol-users (7.9% vs. 3.9%; p=0.045, after adjustment for covariates). We did not detect significant differences in exposure levels between the two treatment arms, perhaps due to large seasonal effects and high ambient air pollution levels. CONCLUSIONS Transition from traditional biomass/kerosene fuel to ethanol reduced adverse pregnancy outcomes. However, the difference in birthweight was statistically significant only after covariate adjustment and the other significant differences were in tertiary endpoints. Our results are suggestive of a beneficial effect of ethanol use. Larger trials are required to validate these findings.
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Affiliation(s)
- Donee A Alexander
- Department of Medicine and Center for Global Health, University of Chicago, Chicago, IL, United States
| | - Amanda Northcross
- Department of Environmental and Occupational Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, United States
| | - Theodore Karrison
- Department of Public Health Sciences, University of Chicago, United States
| | | | - Nathaniel Wilson
- Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Omolola M Atalabi
- Department of Radiology, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria
| | - Anindita Dutta
- Department of Medicine and Center for Global Health, University of Chicago, Chicago, IL, United States
| | - Damilola Adu
- Healthy Life for All Foundation, Ibadan, Nigeria
| | | | | | - Dayo Adepoju
- Healthy Life for All Foundation, Ibadan, Nigeria
| | - Oladosu Ojengbede
- Department of Obstetrics and Gynecology, University of Ibadan, Ibadan, Nigeria
| | - Christopher O Olopade
- Department of Medicine and Center for Global Health, University of Chicago, Chicago, IL, United States.
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Chaiworapongsa T, Romero R, Erez O, Tarca AL, Conde-Agudelo A, Chaemsaithong P, Kim CJ, Kim YM, Kim JS, Yoon BH, Hassan SS, Yeo L, Korzeniewski SJ. The prediction of fetal death with a simple maternal blood test at 20-24 weeks: a role for angiogenic index-1 (PlGF/sVEGFR-1 ratio). Am J Obstet Gynecol 2017; 217:682.e1-682.e13. [PMID: 29037482 PMCID: PMC5951183 DOI: 10.1016/j.ajog.2017.10.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 09/29/2017] [Accepted: 10/01/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Fetal death is an obstetrical syndrome that annually affects 2.4 to 3 million pregnancies worldwide, including more than 20,000 in the United States each year. Currently, there is no test available to identify patients at risk for this pregnancy complication. OBJECTIVE We sought to determine if maternal plasma concentrations of angiogenic and antiangiogenic factors measured at 24-28 weeks of gestation can predict subsequent fetal death. STUDY DESIGN A case-cohort study was designed to include 1000 randomly selected subjects and all remaining fetal deaths (cases) from a cohort of 4006 women with a singleton pregnancy, enrolled at 6-22 weeks of gestation, in a pregnancy biomarker cohort study. The placentas of all fetal deaths were histologically examined by pathologists who used a standardized protocol and were blinded to patient outcomes. Placental growth factor, soluble endoglin, and soluble vascular endothelial growth factor receptor-1 concentrations were measured by enzyme-linked immunosorbent assays. Quantiles of the analyte concentrations (or concentration ratios) were estimated as a function of gestational age among women who delivered a live neonate but did not develop preeclampsia or deliver a small-for-gestational-age newborn. A positive test was defined as analyte concentrations (or ratios) <2.5th and 10th centiles (placental growth factor, placental growth factor/soluble vascular endothelial growth factor receptor-1 [angiogenic index-1] and placental growth factor/soluble endoglin) or >90th and 97.5th centiles (soluble vascular endothelial growth factor receptor-1 and soluble endoglin). Inverse probability weighting was used to reflect the parent cohort when estimating the relative risk. RESULTS There were 11 fetal deaths and 829 controls with samples available for analysis between 24-28 weeks of gestation. Three fetal deaths occurred <28 weeks and 8 occurred ≥28 weeks of gestation. The rate of placental lesions consistent with maternal vascular underperfusion was 33.3% (1/3) among those who had a fetal death <28 weeks and 87.5% (7/8) of those who had this complication ≥28 weeks of gestation. The maternal plasma angiogenic index-1 value was <10th centile in 63.6% (7/11) of the fetal death group and in 11.1% (92/829) of the controls. The angiogenic index-1 value was <2.5th centile in 54.5% (6/11) of the fetal death group and in 3.7% (31/829) of the controls. An angiogenic index-1 value <2.5th centile had the largest positive likelihood ratio for predicting fetal death >24 weeks (14.6; 95% confidence interval, 7.7-27.7) and a relative risk of 29.1 (95% confidence interval, 8.8-97.1), followed by soluble endoglin >97.5th centile and placental growth factor/soluble endoglin <2.5th, both with a positive likelihood ratio of 13.7 (95% confidence interval, 7.3-25.8) and a relative risk of 27.4 (95% confidence interval, 8.2-91.2). Among women without a fetal death whose plasma angiogenic index-1 concentration ratio was <2.5th centile, 61% (19/31) developed preeclampsia or delivered a small-for-gestational-age neonate; when the 10th centile was used as the cut-off, 37% (34/92) of women had these adverse outcomes. CONCLUSION (1) A maternal plasma angiogenic index-1 value <2.5th centile (0.126) at 24-28 weeks of gestation carries a 29-fold increase in the risk of subsequent fetal death and identifies 55% of subsequent fetal deaths with a false-positive rate of 3.5%; and (2) 61% of women who have a false-positive test result will subsequently experience adverse pregnancy outcomes.
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Affiliation(s)
- Tinnakorn Chaiworapongsa
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Roberto Romero
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI; Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI; Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI.
| | - Offer Erez
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI; Department of Obstetrics and Gynecology, Soroka University Medical Center, School of Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Adi L Tarca
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Agustin Conde-Agudelo
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, and Detroit, MI
| | - Piya Chaemsaithong
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Chong Jai Kim
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yeon Mee Kim
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Pathology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Jung-Sun Kim
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Bo Hyun Yoon
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sonia S Hassan
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Lami Yeo
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Steven J Korzeniewski
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI; Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI
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Yao R, Park BY, Foster SE, Caughey AB. The association between gestational weight gain and risk of stillbirth: a population-based cohort study. Ann Epidemiol 2017; 27:638-644.e1. [PMID: 28969875 DOI: 10.1016/j.annepidem.2017.09.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 09/06/2017] [Accepted: 09/11/2017] [Indexed: 11/15/2022]
Abstract
PURPOSE To estimate the risk of stillbirth associated with excessive and inadequate weight gain during pregnancy. METHODS Retrospective cohort study using the Texas vital records database between 2006 and 2011, with 2,230,310 births (5502 stillbirths) was included for analysis. Pregnancies were categorized as adequate weight gain, excessive weight gain, inadequate weight gain, or weight loss based on the Institute of Medicine 2009 recommendations. Hazard ratios (HRs) for stillbirth were estimated for each gestational weight-gain stratum using adequate weight gain as the comparison group. The analysis was performed separately for each body mass index (BMI) class. RESULTS Both inadequate weight gain and weight loss were associated with an increased risk of stillbirth for all BMI classes except the morbidly obese group. Highest risk was seen in weight-loss groups after 36 completed weeks (normal weight: HR = 18.85 [8.25-43.09]; overweight: HR = 5.87 [2.99-11.55]; obese: HR = 3.44 [2.34-5.05]). Weight loss was associated with reduced stillbirth risk in morbidly obese women between 24 and 28 weeks (HR = 0.56 [0.34-0.95]). Excess weight gain was associated with an increased risk of stillbirth among obese and morbidly obese women, with highest risk after 36 completed weeks (obese: HR = 2.00 [1.55-2.58]; morbidly obese: HR = 3.16 [2.17-4.62]). In contrast, excess weight gain was associated with reduced risk of stillbirth in normal-weight women between 24 and 28 weeks (HR = 0.57 [0.44-0.70]) and in overweight women between 29 and 33 weeks (HR = 0.62 [0.45-0.85]). Analysis for the underweight group was limited by sample size. Both excessive weight gain and inadequate weight gain were not associated with stillbirth in this group. CONCLUSIONS Stillbirth risk increased with inadequate weight gain and weight loss in all BMI classes except the morbidly obese group, where weight demonstrated a protective effect. Conversely, excessive weight gain was associated with higher risk of stillbirth among obese and morbidly obese women but was protective against stillbirth in lower weight women.
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Affiliation(s)
- Ruofan Yao
- Department of Obstetrics and Gynecology, University of Maryland School of Medicine, Baltimore.
| | - Bo Y Park
- School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Sarah E Foster
- Department of Obstetrics and Gynecology, Drexel University College of Medicine, Philadelphia, PA
| | - Aaron B Caughey
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR
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Zeballos Sarrato S, Villar Castro S, Ramos Navarro C, Zeballos Sarrato G, Sánchez Luna M. Risks factors associated with intra-partum foetal mortality in pre-term infants. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.anpede.2016.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Zeballos Sarrato S, Villar Castro S, Ramos Navarro C, Zeballos Sarrato G, Sánchez Luna M. Factores de riesgo asociados a mortalidad fetal intraparto en recién nacidos pretérmino. An Pediatr (Barc) 2017; 86:127-134. [DOI: 10.1016/j.anpedi.2016.04.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 04/19/2016] [Accepted: 04/22/2016] [Indexed: 10/21/2022] Open
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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: 125] [Impact Index Per Article: 13.9] [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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O'Kane M, Parretti HM, Hughes CA, Sharma M, Woodcock S, Puplampu T, Blakemore AI, Clare K, MacMillan I, Joyce J, Sethi S, Barth JH. Guidelines for the follow-up of patients undergoing bariatric surgery. Clin Obes 2016; 6:210-24. [PMID: 27166136 DOI: 10.1111/cob.12145] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 03/28/2016] [Accepted: 03/29/2016] [Indexed: 12/25/2022]
Abstract
Bariatric surgery can facilitate weight loss and improvement in medical comorbidities. It has a profound impact on nutrition, and patients need access to follow-up and aftercare. NICE CG189 Obesity emphasized the importance of a minimum of 2 years follow-up in the bariatric surgical service and recommended that following discharge from the surgical service, there should be annual monitoring as part of a shared care model of chronic disease management. NHS England Obesity Clinical Reference Group commissioned a multi-professional subgroup, which included patient representatives, to develop bariatric surgery follow-up guidelines. Terms of reference and scope were agreed upon. The group members took responsibility for different sections of the guidelines depending on their areas of expertise and experience. The quality of the evidence was rated and strength graded. Four different shared care models were proposed, taking into account the variation in access to bariatric surgical services and specialist teams across the country. The common features include annual review, ability for a GP to refer back to specialist centre, submission of follow-up data to the national data base to NBSR. Clinical commissioning groups need to ensure that a shared care model is implemented as patient safety and long-term follow-up are important.
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Affiliation(s)
- Mary O'Kane
- Obesity Clinic, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Helen M Parretti
- Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Carly A Hughes
- Fakenham Weight Management Service, North Norfolk Clinical Commissioning Group, Fakenham, UK
- University of East Anglia, Norwich, UK
| | - Manisha Sharma
- Department of Clinical Biochemistry & Bariatrics, Homerton University Hospital NHS Trust, London, UK
| | - Sean Woodcock
- Department of surgery, Northumbria Healthcare NHS Trust, North Shields, UK
| | - Tamara Puplampu
- Bariatric Services, Homerton University Hospital NHS Trust, London, UK
| | - Alexandra I Blakemore
- Department of Medicine, Imperial College London, London, UK
- Department of Life Sciences, Brunel University London, Uxbridge, UK
| | | | | | | | - Su Sethi
- Public Health, North West Specialised Commissioning Team, Warrington, UK
| | - Julian H Barth
- Obesity Clinic, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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O'Kane M, Barth JH. Nutritional follow-up of patients after obesity surgery: best practice. Clin Endocrinol (Oxf) 2016; 84:658-61. [PMID: 26895813 DOI: 10.1111/cen.13041] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 02/02/2016] [Accepted: 02/14/2016] [Indexed: 11/26/2022]
Abstract
Obesity surgery is an appropriate treatment option for patients with severe and complex obesity and helps in the improvement of comorbidities. In the first 2 years following surgery, follow-up is provided by the obesity surgery centre. Ongoing care is then usually returned to the general practitioner. Patients need access to ongoing support and monitoring otherwise may be at risk of developing nutritional deficiencies such as anaemia or protein malnutrition. The British Obesity and Metabolic Surgery Society have developed guidelines on nutritional monitoring and nutritional supplements to support both bariatric centres and general practitioners. The Royal College of General Practitioners and BOMSS have worked collaboratively to develop Ten Top Tips for the management of obesity surgery patients to aid with the long-term management in primary care. Women, planning to get pregnant, need access to preconception advice and additional monitoring during pregnancy. It is essential that long-term data are collected and inputted into the National Bariatric Surgery Register. Obesity surgery improves comorbidities; however, patients must have access to long-term nutritional monitoring.
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Affiliation(s)
- Mary O'Kane
- Obesity Clinic, St James's Hospital, Leeds, UK
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Maghsoudlou S, Cnattingius S, Aarabi M, Montgomery SM, Semnani S, Stephansson O, Wikström AK, Bahmanyar S. Consanguineous marriage, prepregnancy maternal characteristics and stillbirth risk: a population-based case-control study. Acta Obstet Gynecol Scand 2015; 94:1095-101. [DOI: 10.1111/aogs.12699] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 06/13/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Siavash Maghsoudlou
- Clinical Epidemiology Unit; Department of Medicine Solna; Karolinska Institute; Stockholm Sweden
- Faculty of Medicine; Golestan University of Medical Sciences; Gorgan Iran
| | - Sven Cnattingius
- Clinical Epidemiology Unit; Department of Medicine Solna; Karolinska Institute; Stockholm Sweden
| | - Mohsen Aarabi
- Faculty of Medicine; Mazandaran University of Medical Sciences; Sari Iran
| | - Scott M. Montgomery
- Clinical Epidemiology Unit; Department of Medicine Solna; Karolinska Institute; Stockholm Sweden
- Clinical Epidemiology and Biostatistics; Örebro University Hospital & Örebro University; Örebro Sweden
- Research Department of Epidemiology and Public Health; University College London; London UK
| | - Shahriar Semnani
- Faculty of Medicine; Golestan University of Medical Sciences; Gorgan Iran
| | - Olof Stephansson
- Clinical Epidemiology Unit; Department of Medicine Solna; Karolinska Institute; Stockholm Sweden
- Division of Obstetrics and Gynecology; Department of Women's and Children's Health; Karolinska University Hospital and Institute; Stockholm Sweden
| | - Anna-Karin Wikström
- Clinical Epidemiology Unit; Department of Medicine Solna; Karolinska Institute; Stockholm Sweden
- Department of Women's and Children's Health; Uppsala University; Uppsala Sweden
| | - Shahram Bahmanyar
- Faculty of Medicine; Golestan University of Medical Sciences; Gorgan Iran
- Clinical Epidemiology Unit & Center for Pharmacoepidemiology; Department of Medicine; Solna, Karolinska Institute; Stockholm Sweden
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Schwarz C, Schäfers R, Loytved C, Heusser P, Abou-Dakn M, König T, Berger B. Temporal trends in fetal mortality at and beyond term and induction of labor in Germany 2005-2012: data from German routine perinatal monitoring. Arch Gynecol Obstet 2015; 293:335-43. [PMID: 26141654 PMCID: PMC4709369 DOI: 10.1007/s00404-015-3795-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 06/16/2015] [Indexed: 10/26/2022]
Abstract
PURPOSE While a variety of factors may play a role in fetal and neonatal deaths, postmaturity as a cause of stillbirth remains a topic of debate. It still is unclear, whether induction of labor at a particular gestational age may prevent fetal deaths. METHODS A multidisciplinary working group was granted access to the most recent set of relevant German routine perinatal data, comprising all 5,291,011 hospital births from 2005 to 2012. We analyzed correlations in rates of induction of labor (IOL), perinatal mortality (in particular stillbirths) at different gestational ages, and fetal morbidity. Correlations were tested with Pearson's product-moment analysis (α = 5 %). All computations were performed with SPSS version 22. RESULTS Induction rates rose significantly from 16.5 to 21.9 % (r = 0.98; p < 0.001). There were no significant changes in stillbirth rates (0.28-0.35 per 100 births; r = 0.045; p = 0.806). Stillbirth rates 2009-2012 remained stable in all gestational age groups irrespective of induction. Fetal morbidity (one or more ICD-10 codes) rose significantly during 2005-2012. This was true for both children with (from 33 to 37 %, r = 0.784, p < 0.001) and without (from 25 to 31 %, (r = 0.920, p < 0.001) IOL. CONCLUSIONS An increase in IOL at term is not associated with a decline in perinatal mortality. Perinatal morbidity increased with and without induction of labor.
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Affiliation(s)
- Christiane Schwarz
- Gerhard Kienle Lehrstuhl für Medizintheorie, Integrative und Anthroposophische Medizin, Institute for Integrative Medicine (IfIM), Universität Witten/Herdecke, Gemeinschaftskrankenhaus, Gerhard-Kienle-Weg 4, 58313, Herdecke, Germany.
- Midwifery Research and Education Unit, Department of Obstetrics, Gynaecology and Reproductive Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Rainhild Schäfers
- Department of Applied Health Sciences, University of Applied Sciences, Universitätsstraße 105, 44789, Bochum, Germany.
| | - Christine Loytved
- School of Health Professions, Institute of Midwifery, Zurich University of Applied Sciences, Winterthur, Switzerland.
| | - Peter Heusser
- Gerhard Kienle Lehrstuhl für Medizintheorie, Integrative und Anthroposophische Medizin, Institute for Integrative Medicine (IfIM), Universität Witten/Herdecke, Gemeinschaftskrankenhaus, Gerhard-Kienle-Weg 4, 58313, Herdecke, Germany.
| | - Michael Abou-Dakn
- Studiengang Hebammenkunde, Evangelische Hochschule Berlin, Teltower Damm 118-122, 14167, Berlin, Germany.
| | - Thomas König
- AQUA-Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen GmbH, Maschmühlenweg 8-10, 37073, Göttingen, Germany.
| | - Bettina Berger
- Gerhard Kienle Lehrstuhl für Medizintheorie, Integrative und Anthroposophische Medizin, Institute for Integrative Medicine (IfIM), Universität Witten/Herdecke, Gemeinschaftskrankenhaus, Gerhard-Kienle-Weg 4, 58313, Herdecke, Germany.
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Linde A, Pettersson K, Rådestad I. Women's Experiences of Fetal Movements before the Confirmation of Fetal Death--Contractions Misinterpreted as Fetal Movement. Birth 2015; 42:189-94. [PMID: 25703963 DOI: 10.1111/birt.12151] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/01/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Decreased fetal movement often precedes a stillbirth. The objective of this study was to describe women's experiences of fetal movement before the confirmation of fetal death. METHODS Data were collected through a Web-based questionnaire. Women with stillbirths after 28 gestational weeks were self-recruited. Content analysis was used to analyze the answers to one open question. The statements from mothers of a stillborn, born during gestational weeks 28 to 36 were compared with those of a stillborn at term. RESULTS The women's 215 answers were divided into three categories: decreased, weak, and no fetal movement at all; 154 (72%) of the descriptions were divided into three subcategories: decreased and weak movement (106; 49%), no movement at all (35; 16%), and contraction interpreted as movement (13; 6%). The category fetal movement as normal includes 39 (18%) of the descriptions. The third category, extremely vigorous fetal activity followed by no movement at all, includes 22 (10%) of the descriptions. Eight (15%) of the women with stillbirths in gestational weeks 28 to 36 interpreted contractions as fetal movement as compared to 5 (5%) of the women with stillbirths at term. DISCUSSION Uterine contractions can be interpreted as fetal movement. A single episode of extremely vigorous fetal activity can precede fetal death. The majority of the women experienced decreased, weaker, or no fetal movement at all 2 days before fetal death was diagnosed. Mothers should be educated to promptly report changes in fetal movement to their health care providers. Using fetal movement information to evaluate possible fetal distress may lead to reductions in stillbirths.
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Affiliation(s)
- Anders Linde
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Sophiahemmet University, Stockholm, Sweden
| | - Karin Pettersson
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
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Liu LC, Wang YC, Yu MH, Su HY. Major risk factors for stillbirth in different trimesters of pregnancy--a systematic review. Taiwan J Obstet Gynecol 2015; 53:141-5. [PMID: 25017256 DOI: 10.1016/j.tjog.2014.04.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 03/26/2014] [Indexed: 10/25/2022] Open
Abstract
Stillbirth remains an event that has an important impact on global health issues. Different levels of health care between countries suggest that the stillbirth rate may be one of the indicators of the quality of a country's medical system. In this review, major risk factors for stillbirth will be discussed, especially in different trimesters of pregnancy. Early identification of risk factors for stillbirth and appropriate antenatal management may reduce preventable stillbirths and improve general outcomes of pregnancy.
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Affiliation(s)
- Li-Chun Liu
- Department of Obstetrics and Gynecology, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan
| | - Yu-Chi Wang
- Department of Obstetrics and Gynecology, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan
| | - Mu-Hsien Yu
- Department of Obstetrics and Gynecology, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan
| | - Her-Young Su
- Department of Obstetrics and Gynecology, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan.
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Maternal and Paternal Birthplace and Risk of Stillbirth. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2015; 37:314-323. [DOI: 10.1016/s1701-2163(15)30281-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Alves JGB, de Araújo CAFL, Pontes IEA, Guimarães AC, Ray JG. The BRAzil MAGnesium (BRAMAG) trial: a randomized clinical trial of oral magnesium supplementation in pregnancy for the prevention of preterm birth and perinatal and maternal morbidity. BMC Pregnancy Childbirth 2014; 14:222. [PMID: 25005784 PMCID: PMC4096428 DOI: 10.1186/1471-2393-14-222] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 07/04/2014] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Preterm birth is the leading cause of infant mortality globally, including Brazil. We will evaluate whether oral magnesium citrate reduces the risk of placental dysfunction and its negative consequences for both the fetus and mother, which, in turn, should reduce the need for indicated preterm delivery. METHODS/DESIGN We will complete a multicenter, randomized double-blind clinical trial comparing oral magnesium citrate 150 mg twice daily (n = 2000 women) to matched placebo (n = 1000 women), starting at 121/7 to 206/7 weeks gestation and continued until delivery. We will include women at higher risk for placental dysfunction, based on clinical factors from a prior pregnancy (e.g., prior preterm delivery, stillbirth or preeclampsia) or the current pregnancy (e.g., chronic hypertension, pre-pregnancy diabetes mellitus, maternal age > 35 years or pre-pregnancy maternal body mass index > 30 kg/m2). The primary perinatal outcome is a composite of preterm birth < 37 weeks gestation, stillbirth > 20 weeks gestation, neonatal death < 28 days, or SGA birthweight < 3rd percentile. The primary composite maternal outcome is preeclampsia arising < 37 weeks gestation, severe non-proteinuric hypertension arising < 37 weeks gestation, placental abruption, maternal stroke during pregnancy or ≤ 7 days after delivery, or maternal death during pregnancy or ≤ 7 days after delivery. DISCUSSION The results of this randomized clinical trial may be especially relevant in low and middle income countries that have high rates of prematurity and limited resources for acute newborn and maternal care. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT02032186, registered December 19, 2013.
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Affiliation(s)
| | | | | | | | - Joel G Ray
- Departments of Medicine, Obstetrics and Health Policy Management Evaluation, University of Toronto, St, Michael's Hospital, 30 Bond Street, Toronto, ON M5B 1 W8, Canada.
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Roescher AM, Timmer A, Erwich JJHM, Bos AF. Placental pathology, perinatal death, neonatal outcome, and neurological development: a systematic review. PLoS One 2014; 9:e89419. [PMID: 24586764 PMCID: PMC3934891 DOI: 10.1371/journal.pone.0089419] [Citation(s) in RCA: 116] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 01/21/2014] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The placenta plays a crucial role during pregnancy for growth and development of the fetus. Less than optimal placental performance may result in morbidity or even mortality of both mother and fetus. Awareness among pediatricians, however, of the benefit of placental findings for neonatal care, is limited. OBJECTIVES To provide a systematic overview of the relation between placental lesions and neonatal outcome. DATA SOURCES Pubmed database, reference lists of selected publications and important research groups in the field. STUDY APPRAISAL AND SYNTHESIS METHODS We systematically searched the Pubmed database for literature on the relation between placental lesions and fetal and neonatal mortality, neonatal morbidity and neurological outcome. We conducted three separate searches starting with a search for placental pathology and fetal and neonatal mortality, followed by placental pathology and neonatal morbidity, and finally placental pathology and neurological development. We limited our search to full-text articles published in English from January 1995 to October 2013. We refined our search results by selecting the appropriate articles from the ones found during the initial searches. The first selection was based on the title, the second on the abstract, and the third on the full article. The quality of the selected articles was determined by using the Newcastle-Ottawa Quality Assessment Scale. RESULTS Placental lesions are one of the main causes of fetal death, where placental lesions consistent with maternal vascular underperfusion are most important. Several neonatal problems are also associated with placental lesions, whereby ascending intrauterine infection (with a fetal component) and fetal thrombotic vasculopathy constitute the greatest problem. CONCLUSIONS The placenta plays a key role in fetal and neonatal mortality, morbidity, and outcome. Pediatricians should make an effort to obtain the results of placental examinations.
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Affiliation(s)
- Annemiek M. Roescher
- Division of Neonatology, Beatrix Children's Hospital, University of Groningen, University Medical Center, Groningen, the Netherlands
| | - Albert Timmer
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center, Groningen, the Netherlands
| | - Jan Jaap H. M. Erwich
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center, Groningen, the Netherlands
| | - Arend F. Bos
- Division of Neonatology, Beatrix Children's Hospital, University of Groningen, University Medical Center, Groningen, the Netherlands
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