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Ayele A, Abera S, Edin A, Jara D, Amaje E. Does neonatal resuscitation associated with neonatal death in low-resource settings? A follow-up study. J Matern Fetal Neonatal Med 2024; 37:2285234. [PMID: 38105523 DOI: 10.1080/14767058.2023.2285234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 11/14/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND The newborn period is the most vulnerable phase for a child's survival, with around half of all under-five deaths worldwide occurring during this time. Despite existing policies and measures, Ethiopia ranks among the top 10 African countries in terms of newborn mortality. In spite of many studies being carried out in the country, the incidence and predictors of neonatal mortality in the Pastoralist and agro-pastoralist parts of the country's southern still remain unidentified. Therefore, this study aimed to identify the predictors of neonatal mortality in selected public Hospitals in southern Ethiopia. MATERIALS AND METHODS An institution-based retrospective cohort study was conducted among 568 neonates admitted to the neonatal intensive care unit at Bule Hora University teaching Hospital and Yabelo General Hospital, Southern Ethiopia from 1 January 2020-31 December 2021. A simple random sampling technique was used to select records of neonates. Data entry was performed using Epidata version 3.1 and the analysis was performed using STATA version 14.1 Kaplan Meir curve and Log-rank test were used to estimate the survival time and compare survival curves between variables. Hazard Ratios with 95% CI were computed and all the predictors associated with the outcome variable at p-value 0.05 in the multivariable cox proportional hazards analysis were declared as a significant predictor of neonatal death. RESULTS Out of 565 neonates enrolled, 54(9.56%) neonates died at the end of the follow-up period. The overall incidence rate of death was 17.29 (95% CI: 13.24, 22.57) per 1000 neonatal days with a restricted mean follow-up period of 20 days. Of all deaths, 64.15% of neonates died within the first week of life. In the multivariable cox-proportional hazard model, neonatal age < 7 days (AHR: 9.17, 95% CI: (4.17, 20.13), place of delivery (AHR: 2.48, 95% CI: (1.38, 4.47), Initiation of breastfeeding after 1 h of birth (AHR: 6.46, 95% CI: (2.24, 18.59), neonates' body temperature <36.5 °C (AHR: 2.14, 95% CI: (1.19, 3.83), and resuscitated neonates (AHR: 2.15, 95% CI: (1.20, 3.82) were independent predictors of neonatal death. CONCLUSION In the research setting, the incidence of neonatal death was high, especially during the first week of life. The study found that neonatal age < 7 days, place of delivery, Initiation of breastfeeding after 1 h of birth, neonates' body temperature <36.5 °C, and resuscitated neonates were predictors of neonatal death. To improve newborn survival, significant neonatal problems, improved resuscitation, and other relevant factors should be addressed.
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Affiliation(s)
- Angefa Ayele
- Department of Epidemiology, School of public Health, Institute of Health, Bule Hora University, Bule Hora, Ethiopia
| | - Sewunet Abera
- Department of Epidemiology, School of public Health, Institute of Health, Bule Hora University, Bule Hora, Ethiopia
| | - Alo Edin
- Department of Epidemiology, School of public Health, Institute of Health, Bule Hora University, Bule Hora, Ethiopia
| | - Dube Jara
- Department of Epidemiology, School of public Health, Institute of Health, Bule Hora University, Bule Hora, Ethiopia
- Department of Public Health, College of Health sciences, Salale University, Fiche, Ethiopia
| | - Elias Amaje
- Department of Epidemiology, School of public Health, Institute of Health, Bule Hora University, Bule Hora, Ethiopia
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Zhang P, Tan Z, Li C, Han Z, Zhou J, Yin Y. The correlation between serum total bile acid and adverse perinatal outcomes in pregnant women with intrahepatic cholestasis of pregnancy (ICP) and non-ICP hypercholanemia of pregnancy. Ann Med 2024; 56:2331059. [PMID: 38515230 PMCID: PMC10962286 DOI: 10.1080/07853890.2024.2331059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 02/23/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND The association between excessive serum total bile acid (TBA) and adverse perinatal outcomes in individuals with non-intrahepatic cholestasis of pregnancy (non-ICP) hypercholanemia has not been determined, and it is unclear if this link is similar to that observed in patients with ICP. OBJECTIVE To examine the adverse perinatal outcomes in two specific subcategories: those with ICP and those with non-ICP, including individuals with liver disease and asymptomatic hypercholanemia of pregnancy (AHP), at different levels of TBA. Investigate the correlation between TBA levels and adverse perinatal outcomes of ICP, liver disease, and AHP. METHODS From 2013 to 2021, pregnant women with excessive TBA levels were taken from the electronic medical record database of our hospital and categorized into three groups: ICP (n = 160), liver disease (n = 164), and AHP (n = 650). This was done as part of a retrospective cohort research project. Multivariable regression and subgroup analyses were performed to examine the association between TBA levels and adverse perinatal outcomes in each group. RESULTS The study found no significant differences in adverse perinatal outcomes between the ICP and liver disease groups at different TBA levels. However, at moderate TBA levels, both groups had a higher risk of adverse perinatal outcomes than the AHP group (p < 0.017). Among liver disease cases with TBA ≥ 100µmol/L, three cases of perinatal deaths (6.67%) associated with moderate-to-severe acute hepatitis occurred between 27 and 33 weeks of gestation. A 59% higher chance of perinatal death was found for every 10 µmol/L rise in TBA, even after significant variables and confounders were taken into account (adjusted odds ratio (aOR) = 1.59; 95% confidence interval (CI): 1.06-2.40; p = 0.03). CONCLUSIONS If a pregnant woman has moderate-to-severe liver disease and TBA ≥ 100µmol/L, preterm termination of pregnancy (before 34 weeks) may be considered.
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Affiliation(s)
- Peizhen Zhang
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Zhangmin Tan
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Chuo Li
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Zhenyan Han
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jin Zhou
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yuzhu Yin
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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Tillhof K, Krawzak K, Batza J, Feltman DM. Bereavement Support for Siblings after Neonatal Loss: an Online Survey of U.S. Training Centers. Am J Perinatol 2024; 41:1086-1093. [PMID: 35533680 DOI: 10.1055/s-0042-1748162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE The aim of this study was to examine bereavement support for siblings of patients who die in the neonatal intensive care unit (NICU) given the adverse effects of unprocessed grief and the paucity of information on children whose newborn siblings die STUDY DESIGN: This was an anonymous online original survey assessing pre-COVID-19 pandemic bereavement services for NICU families, clinicians' attitudes toward support interventions, challenges, and center characteristics. In spring 2020, nurse managers at 81 U.S. centers with neonatology and maternal-fetal medicine fellowship programs were asked to identify the individual most knowledgeable in their NICU's bereavement support services; these individuals were invited by email to complete an original online survey. Chi testing and odds ratios (ORs) compared responses from centers reporting involvement of palliative care teams (PCT) in NICU sibling bereavement versus no PCT. RESULTS Fifty-six percent (45 of 80) of invitees responded. Most (77%) NICUs permitted perimortem sibling visitation. Challenges included sparse community resources and limited direct sibling contact. Sixty-nine percent (n = 31) of centers were grouped as PCT. PCT respondents reported eightfold higher chances of providing direct education to the sibling (OR, 7.7; 95% confidence interval, 1.7-34; p = 0.01). Views on appropriateness of sharing educational information with extended family, babysitters, and teachers did not differ. While notifying pediatricians of families experiencing NICU death was more common in PCT (p = 0.02), most respondents reported having "no individual responsible for such communications" (52% PCT vs. 100%, p = 0.001). CONCLUSION Despite limited direct contact with siblings of NICU patients who die, efforts are made to involve them in bereavement activities. Opportunities to support these children were identified. Where available, palliative care teams can help provide bereaved siblings with direct education. We recommend formalizing communication mechanisms to ensure that if a NICU patient dies and has surviving siblings, the outpatient physicians caring for these siblings are informed. KEY POINTS · Palliative care enhanced sibling support.. · Resource and visitation limits hinder support.. · Teams sporadically briefed siblings' physicians..
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Affiliation(s)
- Katie Tillhof
- Evanston Hospital, NorthShore University HealthSystem, Evanston, Illinois
| | - Katie Krawzak
- Advocate Children's Hospital, Advocate Lutheran General Hospital, Park Ridge, Illinois
| | - Jennifer Batza
- Evanston Hospital, NorthShore University HealthSystem, Evanston, Illinois
| | - Dalia M Feltman
- Evanston Hospital, NorthShore University HealthSystem, Evanston, Illinois
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois
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Stanhope KK, Temple JR, Christiansen-Lindquist L, Dudley D, Stoll BJ, Varner M, Hogue CJR. Short Term Coping-Behaviors and Postpartum Health in a Population-Based Study of Women with a Live Birth, Stillbirth, or Neonatal Death. Matern Child Health J 2024; 28:1103-1112. [PMID: 38270716 DOI: 10.1007/s10995-023-03894-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 01/26/2024]
Abstract
OBJECTIVE Responding to the National Institutes of Health Working Group's call for research on the psychological impact of stillbirth, we compared coping-related behaviors by outcome of an index birth (surviving live birth or perinatal loss - stillbirth or neonatal death) and, among individuals with loss, characterized coping strategies and their association with depressive symptoms 6-36 months postpartum. METHODS We used data from the Stillbirth Collaborative Research Network follow-up study (2006-2008) of 285 individuals who experienced a stillbirth, 691 a livebirth, and 49 a neonatal death. We conducted a thematic analysis of coping strategies individuals recommended following their loss. We fit logistic regression models, accounting for sampling and inverse probability of follow-up weights to estimate associations between pregnancy outcomes and coping-related behaviors and, separately, coping strategies and probable depression (Edinburgh Postnatal Depression Scale > 12) for those with loss. RESULTS Compared to those with a surviving live birth and adjusting for pre-pregnancy drinking and smoking, history of stillbirth, and age, individuals who experienced a loss were more likely to report increased drinking or smoking in the two months postpartum (adjusted OR: 2.7, 95% CI = 1.4-5.4). Those who smoked or drank more had greater odds of probable depression at 6 to 36 months postpartum (adjusted OR 6.4, 95% CI = 2.5-16.4). Among those with loss, recommended coping strategies commonly included communication, support groups, memorializing the loss, and spirituality. DISCUSSION Access to a variety of evidence-based and culturally-appropriate positive coping strategies may help individuals experiencing perinatal loss avoid adverse health consequences.
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Affiliation(s)
- Kaitlyn K Stanhope
- Department of Gynecology and Obstetrics, Emory University School of Medicine, 49 Jesse Hill Jr Drive SE, Atlanta, GA, 30303, USA.
| | - Jeff R Temple
- University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA
| | - Lauren Christiansen-Lindquist
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA, 30322, USA
| | - Donald Dudley
- Department of Obstetrics and Gynecology, PO Box 800617, Charlottesville, VA, 22908, USA
| | - Barbara J Stoll
- Department of Pediatrics, Emory School of Medicine, 2015 Uppergate Dr, Atlanta, GA, 30307, USA
| | - Michael Varner
- Department of Obstetrics-Gynecology, University of Utah, 50 North Medical Drive, Salt Lake City, UT, 84132, USA
| | - Carol J R Hogue
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA, 30322, USA
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Sedó SGU, Renaud DL, Molano RA, Santschi DE, Caswell JL, Mee JF, Winder CB. Exploring herd-level perinatal calf mortality risk factors in eastern Canadian dairy farms. J Dairy Sci 2024; 107:3824-3835. [PMID: 38211691 DOI: 10.3168/jds.2023-23854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 11/26/2023] [Indexed: 01/13/2024]
Abstract
This closed cohort study aimed to identify the associations between dairy calf management practices and herd-level perinatal calf mortality risk. From February 2020 to June 2021, predominantly Holstein dairy farms in Québec (n = 1,832) and New Brunswick (n = 52), Canada, that were registered in the dairy herd improvement program were visited once. A questionnaire covering all aspects of precalving, calving, and colostrum management was administered. Data regarding perinatal mortality were retrieved from the dairy herd improvement program database for each farm for 2021. Perinatal mortality was calculated for each farm as the proportion of calves dead at birth or dying within 24 h after birth. A multivariable negative binomial model was used to assess herd-level factors associated with the risk of perinatal mortality. The final model included the lying surface in the calving area, the typical time to first colostrum intake, typical cow-calf contact time, the proportion of males born, the proportion of assisted calvings, and herd size. Herd-level perinatal mortality risk ranged from 0% to 38.1% (mean ± SE = 7.6% ± 0.1%). A greater proportion of males born, a higher proportion of assisted calvings, and delayed colostrum feeding were associated with increased herd-level perinatal mortality. Factors associated with a decreased herd-level perinatal mortality risk were having a typical cow-calf contact time between 7 and 12 h after calving compared with reduced cow-calf contact time, soft lying surfaces in the calving area compared with concrete and mat-lying surfaces, and an increased number of calvings per year. Our results show that although some of the significant risk factors are not well understood (i.e., calving area lying surface, typical cow-calf contact time), Canadian farmers could focus on the factors under their control (i.e., time to first colostrum feeding, proportion of difficult calvings, males born, and calvings per year) to reduce the risk of perinatal mortality. Future work should focus on qualitative research to understand the dairy farmer motivations and limitations to implementing practices identified in this and other studies to reduce perinatal mortality.
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Affiliation(s)
- S G Umaña Sedó
- Department of Population Medicine, University of Guelph, Ontario, N1G2W1, Canada
| | - D L Renaud
- Department of Population Medicine, University of Guelph, Ontario, N1G2W1, Canada
| | - R A Molano
- Lactanet, Sainte-Anne-de-Bellevue, Québec, H9X 3R4, Canada
| | - D E Santschi
- Lactanet, Sainte-Anne-de-Bellevue, Québec, H9X 3R4, Canada
| | - J L Caswell
- Department of Pathobiology, University of Guelph, Ontario, N1G2W1, Canada
| | - J F Mee
- Teagasc, Moorepark Research Centre, Fermoy, Co. Cork, P61 P302, Ireland
| | - C B Winder
- Department of Population Medicine, University of Guelph, Ontario, N1G2W1, Canada.
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Rubio-Alvarez A, Jiménez-Ramos C, Bravo-Vaquero C, Pulgarín-Pulgarín B, Rodríguez-Almagro J, Hernández-Martínez A. Professional approach to the care of women who have suffered a perinatal loss. Nurs Health Sci 2024; 26:e13116. [PMID: 38566393 DOI: 10.1111/nhs.13116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 03/12/2024] [Accepted: 03/16/2024] [Indexed: 04/04/2024]
Abstract
To understand the experience, training, and needs of midwives in their approach to perinatal grief. A descriptive cross-sectional study was carried out using an online questionnaire with 26 questions related to institutional management and individual clinical practices in the care of a perinatal loss was developed by a team of midwives from the Hospital "La Mancha-Centro" of Alcazar de San Juan (Ciudad Real). Strobe checklist was followed. A total of 267 midwives participated. A total of 92.1% (246) of the centers had specific protocols for action, but each professional applied their own criteria. The presence of a perinatal psychology team was nonexistent according to 88% (235) of those surveyed. Regarding their training and professional experience, 16.5% (44) of the midwives had never received training. Only 4.1% (11) of the midwives felt very prepared to care for women with a perinatal loss. Among the factors associated with greater application of recommended practices in the face of perinatal death by midwives were being a woman, having prior training on care during perinatal death, and a greater perception of preparation (p < 0.05). The perception of lack of preparation on the part of midwives in the accompaniment of these families was high.
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Affiliation(s)
- Ana Rubio-Alvarez
- Department of Obstetrics & Gynaecology, Hospital Universitario de Torrejón, Madrid, Spain
| | - Carmen Jiménez-Ramos
- Department of Obstetrics & Gynaecology, Hospital General de Tomelloso, Tomelloso, Ciudad Real, Spain
| | - Carolina Bravo-Vaquero
- Department of Obstetrics & Gynaecology, Gerencia de Atencion Primaria Alcázar de San Juan, Alcázar de San Juan, Ciudad Real, Spain
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Levy-Coles M, Erez O, Mizrakli Y, Benshalom-Tirosh N, Rabinovich A. The effect of chorionicity on maternal and neonatal outcomes in triplet pregnancies. Eur J Obstet Gynecol Reprod Biol 2024; 296:200-204. [PMID: 38458036 DOI: 10.1016/j.ejogrb.2024.02.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 02/17/2024] [Accepted: 02/22/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVE Triplet gestations are associated with increased maternal, fetal, and neonatal complications particularly early and extreme preterm delivery. Identifying and interrupting the preterm delivery cascade could prevent the fetal, neonatal, and long-term childhood complications. The shared circulation and placental vascular anastomosis are responsible for the occurrence of twin-to-twin transfusion syndrome, selective fetal growth restriction as well as the higher risk of morbidity and mortality observed in mono and dichorionic compared to trichorionic triplet gestations. Thus, the aim of this study was to determine the effect of chorionicity on maternal, fetal, and neonatal outcomes of triplet pregnancies as it has not been fully ascertained. STUDY DESIGN A retrospective population-based cohort study of 125 parturient with triplets' pregnancy who delivered at a single tertiary hospital. RESULTS 98 trichorionic and 27 dichorionic gestations were included. Maternal demographic and obstetric characteristics as well as pregnancy and postpartum complications were similar in the two study groups. The median gestational age at delivery was lower among dichorionic than trichorionic triplet gestations (median 31 vs 33 weeks, p < 0.046). Early (<32 weeks) and extreme preterm delivery (<28 weeks) were more prevalent in the dichorionic than the trichorionic group (early - 56 % vs 34 %, p < 0.038; extreme - 33.3 % vs 8 %, p < 0.002). We found no difference in fetal or newborns' complications and characteristics between the groups. However, the rate of neonatal death was significantly higher in the dichorionic compared to trichorionic triplet gestations (22 % vs 7 %, p < 0.038). A multivariate logistic regression model to determine the variables that contribute to early preterm delivery in triplet gestations showed that women who experienced a past preterm delivery had an independently higher risk for early preterm delivery in the triplet gestation (adj. OR 5.91, 95 % CI 1.16-30.03). Neither maternal age nor chorionicity were found to be independent risk factors for early preterm delivery. CONCLUSIONS Dichorionic triplet gestations exhibit a higher rate of early (<32 weeks) and extreme (<28 weeks) preterm delivery and are more prone to neonatal death compared to trichorionic gestations. Past preterm delivery is an independent risk factor for early preterm delivery in a triplet gestation.
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Affiliation(s)
- Maya Levy-Coles
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Offer Erez
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, Beer Sheva, Israel; Department of Obstetrics and Gynecology, Hutzel Women's Hospital, Wayne State University, Detroit, MI, USA.
| | - Yuval Mizrakli
- Clinical Research Center, Soroka University Medical Center and The Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Neta Benshalom-Tirosh
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Alex Rabinovich
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, Beer Sheva, Israel
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Tsadik M, Legesse AY, Teka H, Abraha HE, Fisseha G, Ebrahim MM, Berhe B, Hadush MY, Gebrekurstos G, Ayele B, Tsegay H, Gebremeskel T, Gebremariam T, Hagos T, Gebreegziabher A, Muoze K, Mulugeta A, Gebregziabher M, Godefay H. Neonatal mortality during the war in Tigray: a cross-sectional community-based study. Lancet Glob Health 2024; 12:e868-e874. [PMID: 38614634 DOI: 10.1016/s2214-109x(24)00057-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 01/11/2024] [Accepted: 02/01/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Neonatal mortality is among the key national and international indicators of health services. The global Sustainable Development Goal target for neonatal mortality is fewer than 12 deaths per 1000 livebirths, by 2030. Neonatal mortality estimates in the 2019 Ethiopian Demographic Health Survey found 25·7 deaths per 1000 livebirths. Subnational surveys specific to Tigray, Ethiopia, reported a neonatal mortality lifetime prevalence of 7·13 deaths. Another government report from the Tigray region estimated a neonatal mortality rate of ten deaths per 1000 livebirths in 2020. Despite the numerous interventions in Ethiopia's Tigray region to achieve the Sustainable Development Goals, the war has disrupted most health services, but the effect on neonatal mortality is unknown. Thus, this study aimed to investigate the magnitude and causes of neonatal mortality during the war in Tigray. METHODS A cross-sectional community-based study was conducted in Tigray to evaluate neonatal mortality that occurred from Nov 4, 2020, to May 30, 2022. Among the 31 districts, 121 tabias were selected using computer-generated random sampling, and 189 087 households were visited. We adopted a validated WHO 2022 verbal autopsy tool, and data were collected using an interviewer-administrated Open Data Kit. In the absence of the mother, other respondents to the verbal autopsy interview were household members aged 18 years and older who provided care during the final illness that led to death. FINDINGS 29 761 livebirths were recorded during the screening of 189 087 households. Verbal autopsy was administered for 1158 households with neonatal deaths. 317 neonates were stillborn, and 841 neonatal deaths were recorded with the WHO 2022 verbal autopsy tool from Nov 4, 2020, to May 30, 2022, in 31 districts. The neonatal mortality rate was 28·2 deaths per 1000 livebirths. 476 (57%) of the 841 neonatal deaths occurred at home and 296 (35%) in health facilities. A high rate of neonatal deaths was reported in rural districts (80% [673 of 841]) compared with urban districts (20% [168 of 841]), and 663 (79%) deaths occurred during the early neonatal period, in the first week of life (0-6 days). The leading causes of neonatal death were asphyxia (35% [291 of 834]), prematurity (30% [247 of 834]), and infection (12% [104 of 834]). Asphyxia (37% [246 of 663]) and infection (28% [50 of 178]) were the leading causes of death for early and late neonatal period deaths, respectively. INTERPRETATION Neonatal mortality in Tigray is high due to preventable causes. An urgent response is needed to prevent the high number of neonatal deaths associated with the depleted health resources and services resulting from the war, and to achieve the Sustainable Development Goal on neonatal mortality. FUNDING UNICEF and United Nations Fund for Population Activities. TRANSLATION For the Tigrigna translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Mache Tsadik
- Department of Reproductive Health, College of Health Sciences, Mekelle University, Tigray, Ethiopia.
| | - Awol Yemane Legesse
- Department of Obstetrics and Gynecology, College of Health Sciences, Mekelle University, Tigray, Ethiopia
| | - Hale Teka
- Department of Obstetrics and Gynecology, College of Health Sciences, Mekelle University, Tigray, Ethiopia
| | - Hiluf Ebuy Abraha
- Hospital Quality, Ayder Comprehensive Specialized Hospital, Mekelle University, Tigray, Ethiopia; Department of Epidemiology, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Girmatsion Fisseha
- Department of Reproductive Health, College of Health Sciences, Mekelle University, Tigray, Ethiopia
| | | | - Bereket Berhe
- School of Medicine, College of Health Sciences, Mekelle University, Tigray, Ethiopia
| | - Martha Yemane Hadush
- Department of Pediatrics and Child Health, College of Health Sciences, Mekelle University, Tigray, Ethiopia
| | | | - Brhane Ayele
- Tigray Health Research Institute, Tigray, Ethiopia
| | - Haile Tsegay
- Maternal and Child Health, Tigray Regional Health Bureau, Tigray, Ethiopia
| | - Tesfit Gebremeskel
- School of Public Health, College of Health Sciences, Mekelle University, Tigray, Ethiopia
| | - Tsega Gebremariam
- Department of Obstetrics and Gynecology, College of Health Sciences, Mekelle University, Tigray, Ethiopia
| | - Tigist Hagos
- Department of Reproductive Health, College of Health Sciences, Mekelle University, Tigray, Ethiopia
| | - Abraha Gebreegziabher
- Department of Pediatrics and Child Health, College of Health Sciences, Mekelle University, Tigray, Ethiopia
| | - Kibrom Muoze
- School of Public Health, College of Health Sciences, Mekelle University, Tigray, Ethiopia
| | - Afewerk Mulugeta
- Department of Nutrition and Dietetics, College of Health Sciences, Mekelle University, Tigray, Ethiopia
| | - Mulugeta Gebregziabher
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Hagos Godefay
- Maternal and Child Health, Tigray Regional Health Bureau, Tigray, Ethiopia
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Willcox ML, Okello IA, Maidwell-Smith A, Tura AK, van den Akker T, Knight M, Dumont A, Muller I. Determinants of behaviors influencing implementation of maternal and perinatal death surveillance and response in low- and middle-income countries: A systematic review of qualitative studies. Int J Gynaecol Obstet 2024; 165:586-600. [PMID: 37727893 DOI: 10.1002/ijgo.15132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 08/29/2023] [Accepted: 08/29/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Maternal and Perinatal Death Surveillance and Review (MPDSR) can reduce mortality but its implementation is often suboptimal, especially in low- and middle-income countries (LMICs). OBJECTIVES To understand the determinants of behaviors influencing implementation of MPDSR in LMICs (through a systematic review of qualitative studies), in order to plan an intervention to improve its implementation. SEARCH STRATEGY Terms for maternal or perinatal death reviews and qualitative studies. SELECTION CRITERIA Qualitative studies regarding implementation of MPDSR in LMICs. DATA COLLECTION AND ANALYSIS We coded the included studies using the Theoretical Domains Framework and COM-B model of behavior change (Capability, Opportunity, Motivation). We developed guiding principles for interventions to improve implementation of MPDSR. MAIN RESULTS Fifty-nine studies met our inclusion criteria. Capabilities required to conduct MPDSR (knowledge and technical/leadership skills) increase cumulatively from community to health facility and leadership levels. Physical and social opportunities depend on adequate data, human and financial resources, and a blame-free environment. All stakeholders were motivated to avoid negative consequences (blame, litigation, disciplinary action). CONCLUSIONS Implementation of MPDSR could be improved by (1) introducing structural changes to reduce negative consequences, (2) strengthening data collection tools and information systems, (3) mobilizing adequate resources, and (4) building capabilities of all stakeholders.
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Affiliation(s)
- Merlin L Willcox
- Primary Care Research Centre, School of Primary Care, Population Sciences and Medical Education, University of Southampton, Aldermoor Health Centre, Southampton, UK
| | - Immaculate A Okello
- Primary Care Research Centre, School of Primary Care, Population Sciences and Medical Education, University of Southampton, Aldermoor Health Centre, Southampton, UK
| | - Alice Maidwell-Smith
- Primary Care Research Centre, School of Primary Care, Population Sciences and Medical Education, University of Southampton, Aldermoor Health Centre, Southampton, UK
| | - Abera Kenay Tura
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Thomas van den Akker
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, the Netherlands
- Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Marian Knight
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | | | - Ingrid Muller
- Primary Care Research Centre, School of Primary Care, Population Sciences and Medical Education, University of Southampton, Aldermoor Health Centre, Southampton, UK
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Cohen E, Fu L, Brown HK, Grandi SM, Boblitz A, Fang J, Austin PC, Nathwani AA, Szentkúti P, Horváth-Puhó E, Sørensen HT, Ray JG. Adverse perinatal events and maternal interpregnancy weight change: A population-based observational study. Int J Gynaecol Obstet 2024; 165:792-800. [PMID: 38100266 DOI: 10.1002/ijgo.15296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 11/22/2023] [Accepted: 11/28/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVE Mothers whose newborn experiences adversity may neglect their own health to care for their affected infant or following a perinatal death. Weight gain after pregnancy is one measure of maternal self-care. We measured interpregnancy weight gain among women whose child had an adverse perinatal event. METHODS This population-based observational study included 192 154 primigravid women with two consecutive singleton births in Ontario, Canada. Outcomes included net weight gain, and adjusted odds ratios (aOR) of moving to a higher body mass index (BMI) category between pregnancies, comparing women whose child did versus did not experience either a perinatal death, prematurity, severe neonatal morbidity, major congenital anomaly, or severe neurologic impairment. RESULTS Perinatal death was associated with a +3.5 kg (95% confidence interval [CI]: 2.1-4.9) net higher maternal weight gain in the subsequent pregnancy. Relative to term births, preterm birth <32 weeks (+3.2 kg, 95% CI: 1.9-4.6), 32-33 weeks (+1.8 kg, 95% CI: 0.7-2.8) and 34-36 weeks (+0.9 kg, 95% CI: 0.6-1.3) were associated with higher net weight gain. Having an infant with severe neonatal morbidity was associated with a +1.2 kg (95% CI: 0.3-2.1) weight gain. Likewise, the aOR of moving to a higher BMI category was 1.27 (95% CI, 1.14-1.42) following a perinatal death, 1.21 (95% CI: 1.04-1.41) after a preterm birth <32 weeks, and 1.11 (95% CI: 1.02-1.22) with severe neonatal morbidity. CONCLUSION Greater interpregnancy weight gain, and movement to a higher BMI category, are each more likely in a woman whose first-born was affected by certain major adverse perinatal events.
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Affiliation(s)
- Eyal Cohen
- Department of Pediatrics and Edwin S.H. Leong Center for Healthy Children, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | | | - Hilary K Brown
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Health & Society, University of Toronto Scarborough, Toronto, Ontario, Canada
| | - Sonia M Grandi
- ICES, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Peter C Austin
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Apsara Ali Nathwani
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Péter Szentkúti
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | - Erzsébet Horváth-Puhó
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
- Clinical Excellence Research Center, Stanford University, Stanford, California, USA
| | - Joel G Ray
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- St. Michael's Hospital Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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11
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Sökmen Y, Koç Z. Perinatal death witnessed by midwifery students during clinical practice and their coping methods: A qualitative study. Nurse Educ Today 2024; 136:106135. [PMID: 38387212 DOI: 10.1016/j.nedt.2024.106135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 01/31/2024] [Accepted: 02/17/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVE The aim of this study was to determine the perinatal death experience of midwifery students during clinical practice and their coping methods. DESIGN A qualitative, descriptive, phenomenological design was used. SETTINGS The study was conducted with midwifery students. PARTICIPANTS The study was conducted with 14 midwifery students at a state university in northern Turkey between April and July 2023. METHODS Perinatal death experiences that students witnessed during clinical practice and their coping methods were analyzed using the individual in-depth interview technique. Data were analyzed using the thematic analysis method. The results obtained from the study were reported according to the COREQ criteria. FINDINGS As a result of the analysis, four main themes: (1) the perception of the concept of death, (2) the first encounter with death, (3) methods of coping with death, and (4) students' suggestions were elicited from the data. Students who witnessed perinatal death were affected by this situation, experienced negative emotions, and resorted to different methods to cope with their negative feelings about death. CONCLUSIONS Midwifery students who witnessed perinatal death were negatively affected emotionally and professionally; therefore, education and policy-oriented regulations are needed to cope with perinatal death.
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Affiliation(s)
- Yasemin Sökmen
- Department of Midwifery, Faculty of Health Sciences, Ondokuz Mayıs University, Samsun, Türkiye.
| | - Zeliha Koç
- Department of Midwifery, Faculty of Health Sciences, Ondokuz Mayıs University, Samsun, Türkiye
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Aman H, Ahmad S, Chala G, Afework M. Determinants of externally visible birth defects among perinatal deaths at Adama Comprehensive Specialized Hospital: a case-control study. BMC Pediatr 2024; 24:260. [PMID: 38641790 PMCID: PMC11031892 DOI: 10.1186/s12887-024-04729-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 03/28/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Birth defects (BDs) are the major causes of infant morbidity and mortality in both developed and developing countries. Regardless of their clinical importance, few studies on predisposing factors have been conducted in Ethiopia. However, due to a lack of advanced diagnostic materials, we only considered the externally visible BDs. OBJECTIVE To assess the determinants of externally visible birth defects among perinatal deaths at Adama Comprehensive Specialized Hospital. METHODS A retrospective unmatched case-control study design was conducted from November 01 to 30, 2021. The sample size was determined by Epi Info version 7 software considering sample size calculation for an unmatched case-control study. A total of 315 participants (63 cases, and 252 controls) were selected by simple random sampling. Data were collected by an open data kit (ODK) and transported to a statical package for social sciences (SPSS) version 26 software for analysis. The bivariate followed by multivariable logistic regression analyses were done to determine the factors associated with the BD. RESULTS This study showed that drinking alcohol during pregnancy (AOR = 6.575; 95% CI: 3.102,13.937), lack of antenatal care (ANC) follow-up during pregnancy (AOR = 2.794; 95% CI: 1.333, 5.859), having a history of stillbirth in a previous pregnancy (AOR = 3.967; 95% CI: 1.772, 8.881), exposure to pesticides during pregnancy (AOR = 4.840; 95% CI: 1.375, 17.034), having a history of BDs in a previous pregnancy (AOR = 4.853; 95% CI: 1.492, 15.788), and lack of folic acid supplementation during early pregnancy (AOR = 4.324; 95% CI: 2.062, 9.067) were significant determinants of externally visible BDs among perinatal deaths. CONCLUSION In this study, alcohol use, exposure to pesticides, and lack of folic acid supplementation during pregnancy were identified as the major determinants of externally visible BDs among perinatal deaths. Thus, health education regarding the associated factors of BDs and their preventive strategies should be given to pregnant mothers.
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Affiliation(s)
- Husen Aman
- Department of Human Anatomy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
| | - Seifadin Ahmad
- Department of Public Health, Institute of Health, Ambo University, Ambo, Ethiopia
| | - Getahun Chala
- Department of Medical Physiology, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Mekbeb Afework
- Department of Anatomy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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13
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Venzor Strader A, Sotz M, Gilbert HN, Miller AC, Lee AC, Rohloff P. A biosocial analysis of perinatal and late neonatal mortality among Indigenous Maya Kaqchikel communities in Tecpán, Guatemala: a mixed-methods study. BMJ Glob Health 2024; 9:e013940. [PMID: 38631704 PMCID: PMC11029291 DOI: 10.1136/bmjgh-2023-013940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 03/27/2024] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION Neonatal mortality is a global public health challenge. Guatemala has the fifth highest neonatal mortality rate in Latin America, and Indigenous communities are particularly impacted. This study aims to understand factors driving neonatal mortality rates among Maya Kaqchikel communities. METHODS We used sequential explanatory mixed methods. The quantitative phase was a secondary analysis of 2014-2016 data from the Global Maternal and Newborn Health Registry from Chimaltenango, Guatemala. Multivariate logistic regression models identified factors associated with perinatal and late neonatal mortality. A number of 33 in-depth interviews were conducted with mothers, traditional Maya midwives and local healthcare professionals to explain quantitative findings. RESULTS Of 33 759 observations, 351 were lost to follow-up. There were 32 559 live births, 670 stillbirths (20/1000 births), 1265 (38/1000 births) perinatal deaths and 409 (12/1000 live births) late neonatal deaths. Factors identified to have statistically significant associations with a higher risk of perinatal or late neonatal mortality include lack of maternal education, maternal height <140 cm, maternal age under 20 or above 35, attending less than four antenatal visits, delivering without a skilled attendant, delivering at a health facility, preterm birth, congenital anomalies and presence of other obstetrical complications. Qualitative participants linked severe mental and emotional distress and inadequate maternal nutrition to heightened neonatal vulnerability. They also highlighted that mistrust in the healthcare system-fueled by language barriers and healthcare workers' use of coercive authority-delayed hospital presentations. They provided examples of cooperative relationships between traditional midwives and healthcare staff that resulted in positive outcomes. CONCLUSION Structural social forces influence neonatal vulnerability in rural Guatemala. When coupled with healthcare system shortcomings, these forces increase mistrust and mortality. Collaborative relationships among healthcare staff, traditional midwives and families may disrupt this cycle.
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Affiliation(s)
- Anahí Venzor Strader
- Department of Global Health and Social Medicine "Blavatnik Institute", Harvard Medical School, Boston, Massachusetts, USA
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Center for Indigenous Health Research, Maya Health Alliance Wuqu' Kawoq, Tecpan, Guatemala
| | - Magda Sotz
- Center for Indigenous Health Research, Maya Health Alliance Wuqu' Kawoq, Tecpan, Guatemala
| | - Hannah N Gilbert
- Department of Global Health and Social Medicine "Blavatnik Institute", Harvard Medical School, Boston, Massachusetts, USA
| | - Ann C Miller
- Department of Global Health and Social Medicine "Blavatnik Institute", Harvard Medical School, Boston, Massachusetts, USA
| | - Anne Cc Lee
- Department of Pediatrics, Global Advancement of Infants and Mothers, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Peter Rohloff
- Center for Indigenous Health Research, Maya Health Alliance Wuqu' Kawoq, Tecpan, Guatemala
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
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14
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Qi Z, Yu H, Chen L, Qu Y, Zhang M, Qi G, Chen S. Analysis and prediction of central nervous system tumor burden in China during 1990-2030. PLoS One 2024; 19:e0300390. [PMID: 38630737 PMCID: PMC11023588 DOI: 10.1371/journal.pone.0300390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 02/27/2024] [Indexed: 04/19/2024] Open
Abstract
Central nervous system (CNS) tumors, due to their unique locations, pose a serious threat to human health and present challenges to modern medicine. These tumors exhibit notable epidemiological characteristics across various ethnicities, regions, and age groups. This study investigated the trend of disease burden of CNS tumors in China from 1990-2019 and predicted the incidence and death rate from 2020-2030. Employing data from the 2019 Global Burden of Disease (GBD) database, we utilized key indicators to scrutinize the disease burden associated with CNS tumors in China. The analysis employed the Joinpoint model to track the trend in disease burden, calculating both the annual percentage change (APC) and average annual percentage change (AAPC). Additionally, the Matlab software facilitated the creation of a gray model to forecast the incidence and death rate of CNS tumors in China spanning from 2020 to 2030." In 2019, the age-standardized incidence rate, prevalence rate, death rate, and disability-adjusted life years (DALYs) associated with CNS tumors in China were among the high level in the world. The standardized prevalence rate and DALYs of CNS tumors in China residents showed a stable fluctuation trend with age; however, age-standardized death and incidence rate demonstrated a generally upward trend with age. In China, the age-standardized prevalence and incidence rate of males were lower than those for female residents, while the age-standardized death rate and DALYs among males surpassed those of females. From 1990-2019, the age-standardized prevalence and incidence rate of CNS tumors in China exhibited an increasing trend. The age-standardized death rate and DALYs showed a contrasting trend. According to the gray model's prediction, incidence rate of CNS tumors would continue rising while the death rate is expected to decline in China from 2020-2023. The burden of CNS tumors in China has shown an upward trajectory, posing significant challenges to their treatment. It is necessary to pay attention to tertiary prevention, start from the perspective of high-risk groups and high-risk factors to reduce the burden of disease, and achieve "early detection, early diagnosis, and early treatment".
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Affiliation(s)
- Zedi Qi
- Department of Neurosurgery, The Fifth Clinical Medical College of Shanxi Medical University, Taiyuan City, Shanxi Province, China
| | - Hongyan Yu
- Department of Pneumology, The First Affiliated Hospital of Hebei North University, Zhangjiakou City, Hebei Province, China
| | - Liangchong Chen
- Department of Neurosurgery, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Zhejiang Chinese Medical University, Wenzhou City, Zhejiang Province, China
| | - Yichen Qu
- Department of Neurosurgery, The Fifth Clinical Medical College of Shanxi Medical University, Taiyuan City, Shanxi Province, China
| | - Mignda Zhang
- Department of Neurosurgery, The Fifth Clinical Medical College of Shanxi Medical University, Taiyuan City, Shanxi Province, China
| | - Guozhang Qi
- Department of Neurosurgery, Trigeminal Neuralgia Hospital of Anyang, Anyang City, Henan Province, China
| | - Shengli Chen
- Department of Neurosurgery, The Fifth Clinical Medical College of Shanxi Medical University, Taiyuan City, Shanxi Province, China
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Zablotski Y, Voigt K, Hoedemaker M, Müller KE, Kellermann L, Arndt H, Volkmann M, Dachrodt L, Stock A. Perinatal mortality in German dairy cattle: Unveiling the importance of cow-level risk factors and their interactions using a multifaceted modelling approach. PLoS One 2024; 19:e0302004. [PMID: 38630747 PMCID: PMC11023303 DOI: 10.1371/journal.pone.0302004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 03/26/2024] [Indexed: 04/19/2024] Open
Abstract
Perinatal mortality (PM) is a common issue on dairy farms, leading to calf losses and increased farming costs. The current knowledge about PM in dairy cattle is, however, limited and previous studies lack comparability. The topic has also primarily been studied in Holstein-Friesian cows and closely related breeds, while other dairy breeds have been largely ignored. Different data collection techniques, definitions of PM, studied variables and statistical approaches further limit the comparability and interpretation of previous studies. This article aims to investigate the factors contributing to PM in two underexplored breeds, Simmental (SIM) and Brown Swiss (BS), while comparing them to German Holstein on German farms, and to employ various modelling techniques to enhance comparability to other studies, and to determine if different statistical methods yield consistent results. A total of 133,942 calving records from 131,657 cows on 721 German farms were analyzed. Amongst these, the proportion of PM (defined as stillbirth or death up to 48 hours of age) was 6.1%. Univariable and multivariable mixed-effects logistic regressions, random forest and multimodel inference via brute-force model selection approaches were used to evaluate risk factors on the individual animal level. Although the balanced random forest did not incorporate the random effect, it yielded results similar to those of the mixed-effect model. The brute-force approach surpassed the widely adopted backwards variable selection method and represented a combination of strengths: it accounted for the random effect similar to mixed-effects regression and generated a variable importance plot similar to random forest. The difficulty of calving, breed and parity of the cow were found to be the most important factors, followed by farm size and season. Additionally, four significant interactions amongst predictors were identified: breed-calving ease, breed-season, parity-season and calving ease-farm size. The combination of factors, such as secondiparous SIM breed on small farms and experiencing easy calving in summer, showed the lowest probability of PM. Conversely, primiparous GH cows on large farms with difficult calving in winter exhibited the highest probability of PM. In order to reduce PM, appropriate management of dystocia, optimal heifer management and a wider use of SIM in dairy production are possible ways forward. It is also important that future studies are conducted to identify farm-specific contributors to higher PM on large farms.
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Affiliation(s)
- Yury Zablotski
- Faculty of Veterinary Medicine, Clinic for Ruminants with Ambulatory and Herd Health Services, Ludwig-Maximilians-Universität München, München, Germany
| | - Katja Voigt
- Faculty of Veterinary Medicine, Clinic for Ruminants with Ambulatory and Herd Health Services, Ludwig-Maximilians-Universität München, München, Germany
| | - Martina Hoedemaker
- Clinic for Cattle, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Kerstin E. Müller
- Faculty of Veterinary Medicine, Clinic for Ruminants, Freie Universität Berlin, Berlin, Germany
| | - Laura Kellermann
- Faculty of Veterinary Medicine, Clinic for Ruminants with Ambulatory and Herd Health Services, Ludwig-Maximilians-Universität München, München, Germany
| | - Heidi Arndt
- Clinic for Cattle, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Maria Volkmann
- Faculty of Veterinary Medicine, Institute for Veterinary Epidemiology and Biostatistics, Freie Universität Berlin, Berlin, Germany
| | - Linda Dachrodt
- Clinic for Cattle, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Annegret Stock
- Faculty of Veterinary Medicine, Clinic for Ruminants, Freie Universität Berlin, Berlin, Germany
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Kashililika C, Millanzi WC, Moshi FV. Predictors of health workers' knowledge of maternal and perinatal deaths surveillance and response system in Morogoro region, Tanzania: An analytical cross-sectional study. Medicine (Baltimore) 2024; 103:e37764. [PMID: 38608061 PMCID: PMC11018231 DOI: 10.1097/md.0000000000037764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 03/08/2024] [Indexed: 04/14/2024] Open
Abstract
This study aimed at assessing the predictors of knowledge about the Maternal and Perinatal Deaths Surveillance and Response (MPDSR) system among health workers in the Morogoro region. It was an analytical cross-sectional study, conducted from April 27 to May 29, 2020. A multistage sampling technique was used to recruit 360 health workers. A semi-structured questionnaire was used to collect the data. Statistical Package for Social Science (SPSS v.20) software was used for data entry and analysis. Bivariate and multivariate logistic regression analyses were used to assess factors associated with knowledge of MPDSR. A total of 105 (29.2%) health workers in the Morogoro region had adequate knowledge of the MPDSR system. After controlling for confounders, predictors of knowledge on the MPDSR system were the level of health facility a health worker was working (n [hospital [adjusted odds ratio [AOR] = 2.668 at 95% confidence intervals [CI] = 1.497-4.753, P = .001]), level of education of a health worker (diploma [AOR = 0.146 at 95% CI = 0.038-0.561, P = .005]), and status of training on MPDSR (trained [AOR = 7.253 at 95% CI = 3.862-13.621, P ≤ .001]). The proportion of health workers with adequate knowledge about the MPDSR system in the Morogoro region is unacceptably low. Factors associated with adequate knowledge were those working in hospitals with higher levels of professional training and those who had ever had training in MPDSR. A cost-effective strategy to improve the level of knowledge regarding MPDSR in this region is highly recommended.
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Affiliation(s)
- Christina Kashililika
- Department of Clinical Nursing, School of Nursing and Public Health of the University of Dodoma, Dodoma, Tanzania
| | - Walter C. Millanzi
- Department of Nursing Management and Education, School of Nursing and Public Health of the University of Dodoma, Dodoma, Tanzania
| | - Fabiola Vincent Moshi
- Department of Clinical Nursing, School of Nursing and Public Health of the University of Dodoma, Dodoma, Tanzania
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Rouzer SK, Sreeram A, Miranda RC. Reduced fetal cerebral blood flow predicts perinatal mortality in a mouse model of prenatal alcohol and cannabinoid exposure. BMC Pregnancy Childbirth 2024; 24:263. [PMID: 38605299 PMCID: PMC11007973 DOI: 10.1186/s12884-024-06436-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 03/19/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Children exposed prenatally to alcohol or cannabinoids individually can exhibit growth deficits and increased risk for adverse birth outcomes. However, these drugs are often co-consumed and their combined effects on early brain development are virtually unknown. The blood vessels of the fetal brain emerge and mature during the neurogenic period to support nutritional needs of the rapidly growing brain, and teratogenic exposure during this gestational window may therefore impair fetal cerebrovascular development. STUDY DESIGN To determine whether prenatal polysubstance exposure confers additional risk for impaired fetal-directed blood flow, we performed high resolution in vivo ultrasound imaging in C57Bl/6J pregnant mice. After pregnancy confirmation, dams were randomly assigned to one of four groups: drug-free control, alcohol-exposed, cannabinoid-exposed or alcohol-and-cannabinoid-exposed. Drug exposure occurred daily between Gestational Days 12-15, equivalent to the transition between the first and second trimesters in humans. Dams first received an intraperitoneal injection of either cannabinoid agonist CP-55,940 (750 µg/kg) or volume-equivalent vehicle. Then, dams were placed in vapor chambers for 30 min of inhalation of either ethanol or room air. Dams underwent ultrasound imaging on three days of pregnancy: Gestational Day 11 (pre-exposure), Gestational Day 13.5 (peri-exposure) and Gestational Day 16 (post-exposure). RESULTS All drug exposures decreased fetal cranial blood flow 24-hours after the final exposure episode, though combined alcohol and cannabinoid co-exposure reduced internal carotid artery blood flow relative to all other exposures. Umbilical artery metrics were not affected by drug exposure, indicating a specific vulnerability of fetal cranial circulation. Cannabinoid exposure significantly reduced cerebroplacental ratios, mirroring prior findings in cannabis-exposed human fetuses. Post-exposure cerebroplacental ratios significantly predicted subsequent perinatal mortality (p = 0.019, area under the curve, 0.772; sensitivity, 81%; specificity, 85.70%) and retroactively diagnosed prior drug exposure (p = 0.005; AUC, 0.861; sensitivity, 86.40%; specificity, 66.7%). CONCLUSIONS Fetal cerebrovasculature is significantly impaired by exposure to alcohol or cannabinoids, and co-exposure confers additional risk for adverse birth outcomes. Considering the rising potency and global availability of cannabis products, there is an imperative for research to explore translational models of prenatal drug exposure, including polysubstance models, to inform appropriate strategies for treatment and care in pregnancies affected by drug exposure.
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Affiliation(s)
- Siara Kate Rouzer
- Department of Neuroscience and Experimental Therapeutics, Texas A&M School of Medicine, 8447 Riverside Parkway, Bryan, TX, 77807, USA
| | - Anirudh Sreeram
- Department of Neuroscience and Experimental Therapeutics, Texas A&M School of Medicine, 8447 Riverside Parkway, Bryan, TX, 77807, USA
| | - Rajesh C Miranda
- Department of Neuroscience and Experimental Therapeutics, Texas A&M School of Medicine, 8447 Riverside Parkway, Bryan, TX, 77807, USA.
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Sandall J, Fernandez Turienzo C, Devane D, Soltani H, Gillespie P, Gates S, Jones LV, Shennan AH, Rayment-Jones H. Midwife continuity of care models versus other models of care for childbearing women. Cochrane Database Syst Rev 2024; 4:CD004667. [PMID: 38597126 PMCID: PMC11005019 DOI: 10.1002/14651858.cd004667.pub6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
BACKGROUND Midwives are primary providers of care for childbearing women globally and there is a need to establish whether there are differences in effectiveness between midwife continuity of care models and other models of care. This is an update of a review published in 2016. OBJECTIVES To compare the effects of midwife continuity of care models with other models of care for childbearing women and their infants. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Trials Register, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform (ICTRP) (17 August 2022), as well as the reference lists of retrieved studies. SELECTION CRITERIA All published and unpublished trials in which pregnant women are randomly allocated to midwife continuity of care models or other models of care during pregnancy and birth. DATA COLLECTION AND ANALYSIS Two authors independently assessed studies for inclusion criteria, scientific integrity, and risk of bias, and carried out data extraction and entry. Primary outcomes were spontaneous vaginal birth, caesarean section, regional anaesthesia, intact perineum, fetal loss after 24 weeks gestation, preterm birth, and neonatal death. We used GRADE to rate the certainty of evidence. MAIN RESULTS We included 17 studies involving 18,533 randomised women. We assessed all studies as being at low risk of scientific integrity/trustworthiness concerns. Studies were conducted in Australia, Canada, China, Ireland, and the United Kingdom. The majority of the included studies did not include women at high risk of complications. There are three ongoing studies targeting disadvantaged women. Primary outcomes Based on control group risks observed in the studies, midwife continuity of care models, as compared to other models of care, likely increase spontaneous vaginal birth from 66% to 70% (risk ratio (RR) 1.05, 95% confidence interval (CI) 1.03 to 1.07; 15 studies, 17,864 participants; moderate-certainty evidence), likelyreduce caesarean sections from 16% to 15% (RR 0.91, 95% CI 0.84 to 0.99; 16 studies, 18,037 participants; moderate-certainty evidence), and likely result in little to no difference in intact perineum (29% in other care models and 31% in midwife continuity of care models, average RR 1.05, 95% CI 0.98 to 1.12; 12 studies, 14,268 participants; moderate-certainty evidence). There may belittle or no difference in preterm birth (< 37 weeks) (6% under both care models, average RR 0.95, 95% CI 0.78 to 1.16; 10 studies, 13,850 participants; low-certainty evidence). We arevery uncertain about the effect of midwife continuity of care models on regional analgesia (average RR 0.85, 95% CI 0.79 to 0.92; 15 studies, 17,754 participants, very low-certainty evidence), fetal loss at or after 24 weeks gestation (average RR 1.24, 95% CI 0.73 to 2.13; 12 studies, 16,122 participants; very low-certainty evidence), and neonatal death (average RR 0.85, 95% CI 0.43 to 1.71; 10 studies, 14,718 participants; very low-certainty evidence). Secondary outcomes When compared to other models of care, midwife continuity of care models likely reduce instrumental vaginal birth (forceps/vacuum) from 14% to 13% (average RR 0.89, 95% CI 0.83 to 0.96; 14 studies, 17,769 participants; moderate-certainty evidence), and may reduceepisiotomy 23% to 19% (average RR 0.83, 95% CI 0.77 to 0.91; 15 studies, 17,839 participants; low-certainty evidence). When compared to other models of care, midwife continuity of care models likelyresult in little to no difference inpostpartum haemorrhage (average RR 0.92, 95% CI 0.82 to 1.03; 11 studies, 14,407 participants; moderate-certainty evidence) and admission to special care nursery/neonatal intensive care unit (average RR 0.89, 95% CI 0.77 to 1.03; 13 studies, 16,260 participants; moderate-certainty evidence). There may be little or no difference in induction of labour (average RR 0.92, 95% CI 0.85 to 1.00; 14 studies, 17,666 participants; low-certainty evidence), breastfeeding initiation (average RR 1.06, 95% CI 1.00 to 1.12; 8 studies, 8575 participants; low-certainty evidence), and birth weight less than 2500 g (average RR 0.92, 95% CI 0.79 to 1.08; 9 studies, 12,420 participants; low-certainty evidence). We are very uncertain about the effect of midwife continuity of care models compared to other models of care onthird or fourth-degree tear (average RR 1.10, 95% CI 0.81 to 1.49; 7 studies, 9437 participants; very low-certainty evidence), maternal readmission within 28 days (average RR 1.52, 95% CI 0.78 to 2.96; 1 study, 1195 participants; very low-certainty evidence), attendance at birth by a known midwife (average RR 9.13, 95% CI 5.87 to 14.21; 11 studies, 9273 participants; very low-certainty evidence), Apgar score less than or equal to seven at five minutes (average RR 0.95, 95% CI 0.72 to 1.24; 13 studies, 12,806 participants; very low-certainty evidence) andfetal loss before 24 weeks gestation (average RR 0.82, 95% CI 0.67 to 1.01; 12 studies, 15,913 participants; very low-certainty evidence). No maternal deaths were reported across three studies. Although the observed risk of adverse events was similar between midwifery continuity of care models and other models, our confidence in the findings was limited. Our confidence in the findings was lowered by possible risks of bias, inconsistency, and imprecision of some estimates. There were no available data for the outcomes: maternal health status, neonatal readmission within 28 days, infant health status, and birth weight of 4000 g or more. Maternal experiences and cost implications are described narratively. Women receiving care from midwife continuity of care models, as opposed to other care models, generally reported more positive experiences during pregnancy, labour, and postpartum. Cost savings were noted in the antenatal and intrapartum periods in midwife continuity of care models. AUTHORS' CONCLUSIONS Women receiving midwife continuity of care models were less likely to experience a caesarean section and instrumental birth, and may be less likely to experience episiotomy. They were more likely to experience spontaneous vaginal birth and report a positive experience. The certainty of some findings varies due to possible risks of bias, inconsistencies, and imprecision of some estimates. Future research should focus on the impact on women with social risk factors, and those at higher risk of complications, and implementation and scaling up of midwife continuity of care models, with emphasis on low- and middle-income countries.
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Affiliation(s)
- Jane Sandall
- Department of Women and Children's Health, School of Life Course and Population Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Cristina Fernandez Turienzo
- Department of Women and Children's Health, School of Life Course and Population Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Declan Devane
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
- Evidence Synthesis Ireland and Cochrane Ireland, University of Galway, Galway, Ireland
| | - Hora Soltani
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
| | - Paddy Gillespie
- Health Economics and Policy Analysis Centre, School of Business and Economics, Institute for Lifecourse and Society, University of Galway, Galway, Ireland
| | - Simon Gates
- Cancer Research UK Clinical Trials Unit, School of Cancer Sciences, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Leanne V Jones
- Cochrane Pregnancy and Childbirth, Department of Women's and Children's Health, The University of Liverpool, Liverpool, UK
| | - Andrew H Shennan
- Department of Women and Children's Health, School of Life Course and Population Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Hannah Rayment-Jones
- Department of Women and Children's Health, School of Life Course and Population Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
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Zhao Q, Chen M, Fu L, Yang Y, Zhan Y. Assessing and projecting the global burden of thyroid cancer, 1990-2030: Analysis of the Global Burden of Disease Study. J Glob Health 2024; 14:04090. [PMID: 38577809 PMCID: PMC10995745 DOI: 10.7189/jogh.14.04090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Abstract
Background This study aims to assess the global incidence, mortality, and disability-adjusted life years (DALYs) of thyroid cancer between 1990 and 2030. Methods Our study analysed Global Burden of Disease (GBD) 2019 data from 204 countries, spanning 1990-2019. It focused on age-standardised thyroid cancer incidence, mortality, and disability-adjusted life years (DALYs), using the sociodemographic index (SDI) for assessing socioeconomic levels. Generalised additive models (GAMs) projected thyroid cancer trends for 2020-2030. Results The global burden of thyroid cancer is predicted to increase significantly from 1990 to 2030. The number of thyroid cancer incidence cases is projected to rise from 233 846.64 in 2019 to 305 078.08 by 2030, representing an approximate 30.46% increase. The ASIR (age-standardised incidence rate) is expected to continue its upward trend (estimated annual percentage change (EAPC) = 0.83). The age-standardised death rate (ASDR) for thyroid cancer is projected to decline in both genders, more notably in women (EAPC = -0.34) compared to men (EAPC = -0.17). The burden of disease escalates with advancing age, with significant regional disparities. Regions with lower SDI, particularly in South Asia, are anticipated to witness substantial increases in thyroid cancer incidence from 2020 to 2030. The overall disease burden is expected to rise, especially in countries with low to middle SDI, reflecting broader socio-economic and health care shifts. Conclusions This study highlights significant regional and gender-specific variations in thyroid cancer, with notable increases in incidence rates, particularly in areas like South Asia. These trends suggest improvements in diagnostic capabilities and the influence of socio-economic factors. Additionally, the observed decline in mortality rates across various regions reflects advancements in thyroid cancer management. The findings underline the critical importance of regionally tailored prevention strategies, robust cancer registries, and public health initiatives to address the evolving landscape of thyroid cancer and mitigate health disparities globally.
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Affiliation(s)
- Qizheng Zhao
- Department of Epidemiology, School of Public Health (Shenzhen), Sun Yat-Sen University, Shenzhen, China
| | - Manting Chen
- Department of Epidemiology, School of Public Health (Shenzhen), Sun Yat-Sen University, Shenzhen, China
| | - Leiwen Fu
- Department of Epidemiology, School of Public Health (Shenzhen), Sun Yat-Sen University, Shenzhen, China
| | - Yan Yang
- Department of Nutrition, School of Public Health (Shenzhen), Sun Yat-Sen University, Shenzhen, China
| | - Yiqiang Zhan
- Department of Epidemiology, School of Public Health (Shenzhen), Sun Yat-Sen University, Shenzhen, China
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20
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Taye K, Kebede Y, Tsegaw D, Ketema W. Predictors of neonatal mortality among neonates admitted to the neonatal intensive care unit at Hawassa University Comprehensive Specialized Hospital, Sidama regional state, Ethiopia. BMC Pediatr 2024; 24:237. [PMID: 38570750 PMCID: PMC10988874 DOI: 10.1186/s12887-024-04689-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 03/02/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Despite promising efforts, substantial deaths occurred during the neonatal period. According to estimates from the World Health Organization (WHO), Ethiopia is among the top 10 nations with the highest number of neonatal deaths in 2020 alone. This staggering amount makes it difficult to achieve the SDG (Sustainable Development Goals) target that calls for all nations to work hard to meet a neonatal mortality rate target of ≤ 12 deaths per 1,000 live births by 2030. We evaluated neonatal mortality and it's contributing factors among newborns admitted to the Neonatal Intensive Care Unit (NICU) at Hawassa University Comprehensive Specialized Hospital (HUCSH). METHODS A hospital-based retrospective cross-sectional study on neonates admitted to the NICU from May 2021 to April 2022 was carried out at Hawassa University Comprehensive Specialized Hospital. From the admitted 1044 cases over the study period, 225 babies were sampled using a systematic random sampling procedure. The relationship between variables was determined using bivariate and multivariable analyses, and statistically significant relations were indicated at p-values less than 0.05. RESULTS The magnitude of neonatal death was 14.2% (95% CI: 0.099-0.195). The most common causes of neonatal death were prematurity 14 (43.8%), sepsis 9 (28.1%), Perinatal asphyxia 6 (18.8%), and congenital malformations 3 (9.4%). The overall neonatal mortality rate was 28 per 1000 neonate days. Neonates who had birth asphyxia were 7.28 times more probable (AOR = 7.28; 95% CI: 2.367, 9.02) to die. Newborns who encountered infection within the NICU were 8.17 times more likely (AOR = 8.17; 95% CI: 1.84, 36.23) to die. CONCLUSION The prevalence of newborn death is excessively high. The most common causes of mortality identified were prematurity, sepsis, perinatal asphyxia and congenital anomalies. To avert these causes, we demand that antenatal care services be implemented appropriately, delivery care quality be improved, and appropriate neonatal care and treatment be made available.
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Affiliation(s)
- Kefyalew Taye
- Department of Pediatrics and Child Health, College of Medicine and Health Sciences, School of Medicine, Hawassa University, P.O.Box 1560, Hawassa, Ethiopia
- CEO at Makira Pediatrics and Child Health Specialty clinic, Hawassa, Sidama, Ethiopia
| | - Yenew Kebede
- Department of Pediatrics and Child Health, College of Medicine and Health Sciences, School of Medicine, Hawassa University, P.O.Box 1560, Hawassa, Ethiopia
- Department of Pediatrics and Child Health, College of Medicine and Health Sciences, School of Medicine, Debre Tabor University, Debre Tabor, Ethiopia
| | - Desalegn Tsegaw
- College of Medicine and Health Sciences, School of Public Health, Hawassa University, P.O.Box 1560, Hawassa, Ethiopia
| | - Worku Ketema
- Department of Pediatrics and Child Health, College of Medicine and Health Sciences, School of Medicine, Hawassa University, P.O.Box 1560, Hawassa, Ethiopia.
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21
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Kashililika C, Bakari R, Moshi F. Evaluating health workers attitude towards implementation of maternal and perinatal deaths surveillance and response system in Morogoro region; analytical cross-sectional study. PLoS One 2024; 19:e0300665. [PMID: 38557997 PMCID: PMC10984521 DOI: 10.1371/journal.pone.0300665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 03/01/2024] [Indexed: 04/04/2024] Open
Abstract
Maternal and Perinatal Deaths Review and Surveillance (MPDSR) is a technical system which was issued by the World Health Organization in 2013 to help developing countries improve maternal health. The major purpose of the system was to reduce the ongoing high numbers of maternal deaths and perinatal deaths from avertable causes. Tanzania adopted MPDSR system in 2015. The study aimed to assess health workers attitude towards implementation of MPDSR system in Morogoro Region. This analytical cross-sectional study was conducted in three districts of Morogoro region from April 27, 2020 to May 29, 2020 involving 360 health workers from 38 health facilities. A semi-structured questionnaire was used for data collection. SPSS software version 25 was used to analyze the obtained data. Descriptive analysis was done to describe the characteristics of study participants. Binary logistic regression analysis was used to assess predictors of health workers attitude towards the MPDSR system. A total of 255(70.8%) of respondents had positive attitude towards MPDSR system. After controlling of confounders predictor of positive attitude were location of health facility [rural (AOR = 0.216 at 95% CI = 0.121-0.387, p = <0.001)], Age group [Below 30(AOR = 0.459 at 95%CI = 0.264-0.796, p = 0.006)] and status of training on MPDSR [Yes (AOR = 4.892 at 95%CI = 2.187-10.942, P = <0.001)]. Substantial number of health workers had positive attitude towards the MPDSR system. Health workers who were residing in rural settings and younger than 30 years were less likely to have positive attitude towards the system. Health workers who had access to be trained about the system were more likely to have positive attitude towards MPDSR system. The study recommends the training of health workers about the system so as to increase their attitude and hence the use of the system.
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Affiliation(s)
- Christina Kashililika
- Department of Clinical Nursing, School of Nursing and Public Health of the University of Dodoma, Dodoma, Tanzania
| | - Rehema Bakari
- Department of Clinical Nursing, School of Nursing and Public Health of the University of Dodoma, Dodoma, Tanzania
| | - Fabiola Moshi
- Department of Nursing Management and Education, School of Nursing and Public Health of the University of Dodoma, Dodoma, Tanzania
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22
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Yang S, Shapiro GD, Ng E, Vissandjée B, Vang ZM. Birth and postnatal outcomes among infants of immigrant parents of different admission categories and parents born in Canada: a population-based retrospective study. CMAJ 2024; 196:E394-E409. [PMID: 38565234 PMCID: PMC10984700 DOI: 10.1503/cmaj.230878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Most studies of disparities in birth and postnatal outcomes by parental birthplace combine all immigrants into a single group. We sought to evaluate heterogeneity among immigrants in Canada by comparing birth and postnatal outcomes across different immigration categories. METHODS We conducted a population-based retrospective study using Statistics Canada data on live births and stillbirths (1993-2017) and infant deaths (1993-2018), linked to parental immigration data (1960-2017). We classified birthing parents as born in Canada, economic-class immigrants, family-class immigrants, or refugees, and evaluated differences in preterm births, small-for-gestational-age (SGA) and large-for-gestational-age (LGA) births, stillbirths, and infant deaths among singleton births by group. RESULTS Among 7 980 650 births, 1 715 050 (21.5%) were to immigrants, including 632 760 (36.9%) in the economic class, 853 540 (49.8%) in the family class, and 228 740 (13.4%) refugees. Compared with infants of Canadian-born birthing parents, infants of each of the 3 immigrant groups had higher risk of preterm birth, SGA birth, and stillbirth, but lower risk of LGA birth and neonatal death. Compared with infants of economic-class immigrants, infants of refugees had higher risk of early preterm birth (0.9% v. 0.8%, adjusted risk ratio [RR] 1.08, 95% confidence interval [CI] 1.01-1.15) and LGA birth (9.2% v. 7.5%, adjusted RR 1.12, 95% CI 1.10-1.15), but lower risk of SGA birth (10.2% v. 11.0%, adjusted RR 0.92, 95% CI 0.90-0.94), while infants of family-class immigrants had higher risk of SGA birth (12.2% v. 11.0%, adjusted RR 1.01, 95% CI 1.00-1.02). Risk of stillbirth, neonatal death, and overall infant death did not differ significantly among immigrant groups. INTERPRETATION Heterogeneity exists in outcomes of infants born to immigrants to Canada across immigration categories. These results highlight the importance of disaggregating immigrant populations in studies of health disparities.
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Affiliation(s)
- Seungmi Yang
- Department of Epidemiology, Biostatistics and Occupational Health (Yang, Shapiro), McGill University, Montréal, Que.; Health Analysis Division (Ng), Statistics Canada, Ottawa, Ont.; School of Nursing (Vissandjée), Université de Montréal; School of Human Ecology (Vang), University of Wisconsin-Madison, Madison, Wis.
| | - Gabriel D Shapiro
- Department of Epidemiology, Biostatistics and Occupational Health (Yang, Shapiro), McGill University, Montréal, Que.; Health Analysis Division (Ng), Statistics Canada, Ottawa, Ont.; School of Nursing (Vissandjée), Université de Montréal; School of Human Ecology (Vang), University of Wisconsin-Madison, Madison, Wis
| | - Edward Ng
- Department of Epidemiology, Biostatistics and Occupational Health (Yang, Shapiro), McGill University, Montréal, Que.; Health Analysis Division (Ng), Statistics Canada, Ottawa, Ont.; School of Nursing (Vissandjée), Université de Montréal; School of Human Ecology (Vang), University of Wisconsin-Madison, Madison, Wis
| | - Bilkis Vissandjée
- Department of Epidemiology, Biostatistics and Occupational Health (Yang, Shapiro), McGill University, Montréal, Que.; Health Analysis Division (Ng), Statistics Canada, Ottawa, Ont.; School of Nursing (Vissandjée), Université de Montréal; School of Human Ecology (Vang), University of Wisconsin-Madison, Madison, Wis
| | - Zoua M Vang
- Department of Epidemiology, Biostatistics and Occupational Health (Yang, Shapiro), McGill University, Montréal, Que.; Health Analysis Division (Ng), Statistics Canada, Ottawa, Ont.; School of Nursing (Vissandjée), Université de Montréal; School of Human Ecology (Vang), University of Wisconsin-Madison, Madison, Wis
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23
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Doshi U, Chaiken S, Hersh A, Gibbins KJ, Caughey AB. Treating Mild Chronic Hypertension During Pregnancy: A Cost-Effectiveness Analysis. Obstet Gynecol 2024; 143:562-569. [PMID: 38387029 DOI: 10.1097/aog.0000000000005531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/07/2023] [Indexed: 02/24/2024]
Abstract
OBJECTIVE To assess the cost effectiveness of targeting a blood pressure of less than 140/90 mm Hg compared with 160/105 mm Hg. METHODS A decision-analytic model was constructed to compare the treatment of chronic hypertension in pregnancy at mild-range blood pressures (140/90 mm Hg) with the treatment of chronic hypertension before 20 weeks of gestation at severe-range blood pressures (160/105 mm Hg) in a theoretical cohort of 180,000 patients with mild chronic hypertension. Probabilities, costs, and utilities were derived from literature and varied in sensitivity analyses. Primary outcomes included incremental cost per quality-adjusted life-year (QALY), cases of preeclampsia, preeclampsia with severe features, severe maternal morbidity (SMM), preterm birth, maternal death, neonatal death, and neurodevelopmental delay. The cost-effectiveness threshold was $100,000 per QALY. RESULTS Treating chronic hypertension in a population of 180,000 pregnant persons at mild-range blood pressures, compared with severe-range blood pressures, resulted in 14,177 fewer cases of preeclampsia (43,953 vs 58,130), 11,835 of which were cases of preeclampsia with severe features (40,530 vs 52,365). This led to 817 fewer cases of SMM (4,375 vs 5,192), and 18 fewer cases of maternal death (102 vs 120). Treating at a lower threshold also resulted in 8,078 fewer cases of preterm birth (22,000 vs 30,078), which led to 26 fewer neonatal deaths (276 vs 302) and 157 fewer cases of neurodevelopmental delay (661 vs 818). Overall, treating chronic hypertension at a lower threshold was a dominant strategy that resulted in decreased costs of $600 million and increased effectiveness of 12,852 QALYs. CONCLUSION Treating chronic hypertension at a threshold of mild-range blood pressures is a dominant (lower costs, better outcomes) and cost-effective strategy that results in fewer neonatal and maternal deaths compared with the standard treatment of treating at severe range blood pressures.
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Affiliation(s)
- Uma Doshi
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon
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24
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Lo JO, Shaw B, Robalino S, Ayers CK, Durbin S, Rushkin MC, Olyaei A, Kansagara D, Harrod CS. Cannabis Use in Pregnancy and Neonatal Outcomes: A Systematic Review and Meta-Analysis. Cannabis Cannabinoid Res 2024; 9:470-485. [PMID: 36730710 DOI: 10.1089/can.2022.0262] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Objective: To determine whether prenatal cannabis use alone increases the likelihood of fetal and neonatal morbidity and mortality. Study Design: We searched bibliographic databases, such as PubMed, Embase, Scopus, Cochrane reviews, PsycInfo, MEDLINE, Clinicaltrials.gov, and Google Scholar from inception through February 14, 2022. Cohort or case-control studies with prespecified fetal or neonatal outcomes in pregnancies with prenatal cannabis use. Primary outcomes were preterm birth (PTB; <37 weeks of gestation), small-for-gestational-age (SGA), birthweight (grams), and perinatal mortality. Two independent reviewers screened studies. Studies were extracted by one reviewer and confirmed by a second using a predefined template. Risk of bias assessment of studies, using the Newcastle-Ottawa Quality Assessment Scale, and Grading of Recommendations Assessment, Development, and Evaluation for evaluating the certainty of evidence for select outcomes were performed by two independent reviewers with disagreements resolved by a third. Random effects meta-analyses were conducted, using adjusted and unadjusted effect estimates, to compare groups according to prenatal exposure to cannabis use status. Results: Fifty-three studies were included. Except for birthweight, unadjusted and adjusted meta-analyses had similar results. We found very-low- to low-certainty evidence that cannabis use during pregnancy was significantly associated with greater odds of PTB (adjusted odds ratio [aOR], 1.42; 95% confidence interval [CI], 1.19 to 1.69; I2, 93%; p=0.0001), SGA (aOR, 1.76; 95% CI, 1.52 to 2.05; I2, 86%; p<0.0001), and perinatal mortality (aOR, 1.5; 95% CI, 1.39 to 1.62; I2, 0%; p<0.0001), but not significantly different for birthweight (mean difference, -40.69 g; 95% CI, -124.22 to 42.83; I2, 85%; p=0.29). Because of substantial heterogeneity, we also conducted a narrative synthesis and found comparable results to meta-analyses. Conclusion: Prenatal cannabis use was associated with greater odds of PTB, SGA, and perinatal mortality even after accounting for prenatal tobacco use. However, our confidence in these findings is limited. Limitations of most existing studies was the failure to not include timing or quantity of cannabis use. This review can help guide health care providers with counseling, management, and addressing the limited existing safety data. Protocol Registration: PROSPERO CRD42020172343.
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Affiliation(s)
- Jamie O Lo
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon, USA
| | - Beth Shaw
- Department of Obstetrics and Gynecology, Center for Evidence-Based Policy, Oregon Health and Science University, Portland, Oregon, USA
| | - Shannon Robalino
- Department of Obstetrics and Gynecology, Center for Evidence-Based Policy, Oregon Health and Science University, Portland, Oregon, USA
| | - Chelsea K Ayers
- Center for the Involvement of Veterans in their Care (CIVIC), VA Portland Health Care System, Portland, Oregon, USA
| | - Shauna Durbin
- Department of Obstetrics and Gynecology, Center for Evidence-Based Policy, Oregon Health and Science University, Portland, Oregon, USA
| | - Megan C Rushkin
- Department of Obstetrics and Gynecology, Center for Evidence-Based Policy, Oregon Health and Science University, Portland, Oregon, USA
| | - Amy Olyaei
- Division of Neonatology, Department of Pediatrics, Oregon Health and Science University, Portland, Oregon, USA
| | - Devan Kansagara
- Center for the Involvement of Veterans in their Care (CIVIC), VA Portland Health Care System, Portland, Oregon, USA
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Curtis S Harrod
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Oregon Health and Science University, Portland, Oregon, USA
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Tarvonen M, Markkanen J, Tuppurainen V, Jernman R, Stefanovic V, Andersson S. Intrapartum cardiotocography with simultaneous maternal heart rate registration improves neonatal outcome. Am J Obstet Gynecol 2024; 230:379.e1-379.e12. [PMID: 38272284 DOI: 10.1016/j.ajog.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/11/2024] [Accepted: 01/12/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND Intrapartum cardiotocographic monitoring of fetal heart rate by abdominal external ultrasound transducer without simultaneous maternal heart rate recording has been associated with increased risk of early neonatal death and other asphyxia-related neonatal outcomes. It is unclear, however, whether this increase in risk is independently associated with fetal surveillance method or is attributable to other factors. OBJECTIVE This study aimed to compare different fetal surveillance methods and their association with adverse short- and long-term fetal and neonatal outcomes in a large retrospective cohort of spontaneous term deliveries. STUDY DESIGN Fetal heart rate and maternal heart rate patterns were recorded by cardiotocography during labor in spontaneous term singleton cephalic vaginal deliveries in the Hospital District of Helsinki and Uusimaa, Finland between October 1, 2005, and September 30, 2023. According to the method of cardiotocography monitoring at birth, the cohort was divided into the following 3 groups: women with ultrasound transducer, women with both ultrasound transducer and maternal heart rate transducer, and women with internal fetal scalp electrode. Umbilical artery pH and base excess values, low 1- and 5-minute Apgar scores, need for intubation and resuscitation, neonatal intensive care unit admission for asphyxia, neonatal encephalopathy, and early neonatal death were used as outcome variables. RESULTS Among the 213,798 deliveries that met the inclusion criteria, the monitoring type was external ultrasound transducer in 81,559 (38.1%), both external ultrasound transducer and maternal heart rate recording in 62,268 (29.1%), and fetal scalp electrode in 69,971 (32.7%) cases, respectively. The rates of both neonatal encephalopathy (odds ratio, 1.48; 95% confidence interval, 1.08-2.02) and severe acidemia (umbilical artery pH <7.00 and/or umbilical artery base excess ≤-12.0 mmol/L) (odds ratio, 2.03; 95% confidence interval, 1.65-2.50) were higher in fetuses of women with ultrasound transducer alone compared with those of women with concurrent external fetal and maternal heart rate recording. Monitoring with ultrasound transducer alone was also associated with increased risk of neonatal intubation for resuscitation (odds ratio, 1.22; 95% confidence interval, 1.03-1.44). A greater risk of severe neonatal acidemia was observed both in the ultrasound transducer (odds ratio, 2.78; 95% confidence interval, 2.23-3.48) and concurrent ultrasound transducer and maternal heart rate recording (odds ratio, 1.37; 95% confidence interval, 1.05-1.78) groups compared with those monitored with fetal scalp electrodes. No difference in risk of neonatal encephalopathy was found between newborns monitored with concurrent ultrasound transducer and maternal heart rate recording and those monitored with fetal scalp electrodes. CONCLUSION The use of external ultrasound transducer monitoring of fetal heart rate without simultaneous maternal heart rate recording is associated with higher rates of neonatal encephalopathy and severe neonatal acidemia. We suggest that either external fetal heart rate monitoring with concurrent maternal heart rate recording or internal fetal scalp electrode be used routinely as a fetal surveillance tool in term deliveries.
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Affiliation(s)
- Mikko Tarvonen
- Department of Obstetrics and Gynecology, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.
| | - Janne Markkanen
- Department of Industrial Engineering and Management, LUT University of Technology, Lappeenranta, Finland; Intensive and Intermediate Care Unit, Helsinki University Hospital, Helsinki, Finland
| | - Ville Tuppurainen
- Department of Industrial Engineering and Management, LUT University of Technology, Lappeenranta, Finland; Helsinki University Hospital Area Administration, Helsinki, Finland
| | - Riina Jernman
- Department of Obstetrics and Gynecology, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Vedran Stefanovic
- Department of Obstetrics and Gynecology, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Sture Andersson
- Children's Hospital, Pediatric Research Center, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
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Habibelahi A, Heidarzadeh M, Abdollahi L, Taheri M, Ghaffari-Fam S, Vakilian R, Daemi A. Clinical cause of neonatal mortality in Iran: analysis of the national Iranian Maternal And Neonatal network. BMJ Paediatr Open 2024; 8:e002315. [PMID: 38508661 PMCID: PMC10961515 DOI: 10.1136/bmjpo-2023-002315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 03/07/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND The neonatal mortality rate is a main indicator of the health and development of a country. Having insight into the cause of neonatal deaths may be the first step to reducing it. This paper depicts the cause of newborn deaths in Iran. METHODS This cross-sectional study was performed on data from the national Iranian Maternal And Neonatal network to investigate all neonatal deaths in the country during the year 2019. The cause of death data were reported according to categories of birth weight, gestational age (GA), death time and place. RESULTS The main causes of the 9959 neonatal deaths during the study period were respiratory distress syndrome (RDS) (37%), malformation (21%), prematurity of <26 weeks (20%), others (12%), asphyxia (7%) and infection (3%). The major causes of neonatal mortality in delivery rooms were prematurity of <26 weeks and in the inpatient wards the RDS. By increasing the GA and birth weight towards term babies, the rate of RDS gets lower, while that of malformation gets higher. CONCLUSIONS RDS was the main cause of neonatal mortality in Iran which is seen mainly in preterm babies. Prematurity of <26 weeks was another main cause. Thus, suggestions include reducing prematurity by preconception and pregnancy care and, on the other hand, improving the care of preterm infants in delivery rooms and inpatient wards.
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Affiliation(s)
- Abbas Habibelahi
- Iran Ministry of Health and Medical Education, Tehran, Iran (the Islamic Republic of)
| | | | - Leila Abdollahi
- Department of Health Services Management, Iran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Majzoubeh Taheri
- Iran Ministry of Health and Medical Education, Tehran, Iran (the Islamic Republic of)
| | - Saber Ghaffari-Fam
- Department of Epidemiology, Hamadan University of Medical Sciences, Hamadan, Iran (the Islamic Republic of)
| | - Roshanak Vakilian
- Iran Ministry of Health and Medical Education, Tehran, Iran (the Islamic Republic of)
| | - Amin Daemi
- Department of Health Services Management, Iran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
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Tembo D, Abobo FDN, Kaonga P, Jacobs C, Bessing B. Risk factors associated with neonatal mortality among neonates admitted to neonatal intensive care unit of the University Teaching Hospital in Lusaka. Sci Rep 2024; 14:5231. [PMID: 38433271 PMCID: PMC10909865 DOI: 10.1038/s41598-024-56020-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/29/2024] [Indexed: 03/05/2024] Open
Abstract
Globally, several children die shortly after birth and many more of them within the first 28 days of life. Sub-Sharan Africa accounts for almost half (43%) of the global neonatal death with slow progress in reduction. These neonatal deaths are associated with lack of quality care at or immediately after birth and in the first 28 days of life. This study aimed to determine the trends and risk factors of facility-based neonatal mortality in a major referral hospital in Lusaka, Zambia. We conducted retrospective analysis involving all neonates admitted in the University Teaching Hospital Neonatal Intensive Care Unit (UTH-NICU) in Lusaka from January 2018 to December 2019 (N = 2340). We determined the trends and assessed the factors associated with facility-based neonatal mortality using Generalized Linear Models (GLM) with a Poisson distribution and log link function. Overall, the facility-based neonatal mortality was 40.2% (95% CI 38.0-42.0) per 1000 live births for the 2-year period with a slight decline in mortality rate from 42.9% (95% CI 40.0-46.0) in 2018 to 37.3% (95% CI 35.0-40.0) in 2019. In a final multivariable model, home delivery (ARR: 1.70, 95% CI 1.46-1.96), preterm birth (ARR: 1.59, 95% CI 1.36-1.85), congenital anomalies (ARR: 1.59, 95% CI 1.34-1.88), low birthweight (ARR: 1.57, 95% CI 1.37-1.79), and health centre delivery (ARR: 1.48, 95% CI 1.25-1.75) were independently associated with increase in facility-based neonatal mortality. Conversely, hypothermia (ARR: 0.36, 95% CI 0.22-0.60), antenatal attendance (ARR: 0.76, 95% CI 0.68-0.85), and 1-day increase in neonatal age (ARR: 0.96, 95% CI 0.95-0.97) were independently associated with reduction in facility-based neonatal mortality. In this hospital-based study, neonatal mortality was high compared to the national and global targets. The improvement in neonatal survival observed in this study may be due to interventions including Kangaroo mother care already being implemented. Early identification and interventions to reduce the impact of risks factors of neonatal mortality in Zambia are important.
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Affiliation(s)
- Deborah Tembo
- School of Public Health, Department of Epidemiology and Biostatistics, University of Zambia, Lusaka, Zambia.
- Zambia National Public Health Institute, Lusaka, Zambia.
| | | | - Patrick Kaonga
- School of Public Health, Department of Epidemiology and Biostatistics, University of Zambia, Lusaka, Zambia
| | - Choolwe Jacobs
- School of Public Health, Department of Epidemiology and Biostatistics, University of Zambia, Lusaka, Zambia
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Qiu L, Lv M, Chen L, Chen Z, Shen J, Wang M, Cai Y, Zhao B, Luo Q. Comparison of two emergency cervical cerclage techniques in twin pregnancies: A retrospective cohort study matched with cervical dilation. Int J Gynaecol Obstet 2024; 164:1036-1046. [PMID: 37712448 DOI: 10.1002/ijgo.15081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/05/2023] [Accepted: 08/17/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVES This retrospective cohort study aimed to assess the efficacy of emergency cervical cerclage (ECC) performed with the combined McDonald-Shirodkar technique in twin pregnancies between 18 and 26 weeks of pregnancy with painless cervical dilation 1 to 6 cm. METHODS A retrospective cohort study matched with the degree of cervical dilation was conducted. The study group (case group) included women with twin pregnancies undergoing combined McDonald-Shirodkar approach with cervical dilation ≥1 cm between 18 to 26 weeks of gestation at four institutions, from December 2015 to December 2022. To minimize confounding factors, we elucidated the causality structure using a directed acyclic graph and performed 1:1 case-control matching. A control group underwent the McDonald approach. The primary outcome was gestational age (GA) at delivery. The secondary outcomes were pregnancy latency; the rates of spontaneous preterm birth at <28, <30, <32, and <34 weeks; and neonatal outcomes. Additional subanalysis was performed by dividing the patients into two subgroups of women with cervical dilation ≥3 cm and <3 cm. RESULTS A total of 84 twin pregnancies were managed with either the combined McDonald-Shirodkar approach (case group: n = 42) or the McDonald approach (control group: n = 42). Demographic characteristics were not significantly different in the two groups (P > 0.05). After adjusting for confounders that were represented by a directed acyclic graph, median GA at delivery was significantly higher (30.5 vs 27 weeks; Bate: 3.40 [95% confidence interval (CI), 2.13-4.67], P < 0.001) and median pregnancy latency was significantly longer (56 vs 28 days; Bate: 24.04 [95% CI, 13.31-34.78], P < 0.001) in the case group compared with the control group. Rates of spontaneous preterm birth at <28, <30, <32, and <34 weeks were significantly lower in the case group than in the control group. For neonatal outcomes, there was higher birth weight (1543.75 vs 980 g; Bate: 420.08 [95% CI, 192.18-647.98], P < 0.001) and significantly lower overall perinatal mortality (7.1% vs 31%; adjusted odds ratio, 0.16 [95% CI, 0.04-0.70], P = 0.014) in the case group compared with the control group. When cervical dilation was ≥3 cm, the combined McDonald-Shirodkar procedure can significantly reduce perinatal mortality (8.3% vs 46.7%; adjusted odds ratio, 0.09 [95% CI, 0.01-0.77], P = 0.028), significantly decrease the risk of delivery at <28 and <30 weeks, and prolong GA at delivery and pregnancy latency compared with the McDonald procedure. CONCLUSIONS ECC performed with the combined McDonald-Shirodkar procedure in women with twin pregnancies who have cervical dilation 1 to 6 cm in midtrimester pregnancy may reduce the rate of spontaneous preterm birth and improve perinatal and neonatal outcomes compared with the McDonald procedure, especially for twin pregnancies in women with cervical dilation of 3 to 6 cm and prolapsed membranes.
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Affiliation(s)
- Liping Qiu
- Department of Obstetrics, Huzhou Maternity & Child Health Care Hospital, Huzhou, Zhejiang, China
| | - Min Lv
- Department of Obstetrics, Women's Hospital, Zhejiang University, School of Medicine, Hangzhou, Zhejiang, China
| | - Lujiao Chen
- Department of Obstetrics, Zhejiang University, School of Medicine, Hangzhou, Zhejiang, China
| | - Zi Chen
- Department of Obstetrics, Zhejiang University, School of Medicine, Hangzhou, Zhejiang, China
| | - Jayan Shen
- Department of Obstetrics, Huzhou Maternity & Child Health Care Hospital, Huzhou, Zhejiang, China
| | - Minmin Wang
- Department of Obstetrics, The First People's Hospital of Fuyang, Fuyang, Zhejiang, China
| | - Yuliang Cai
- Department of Obstetrics, Shaoxing Maternity & Child Health Care Hospital, Shaoxing, Zhejiang, China
| | - Baihui Zhao
- Department of Obstetrics, Women's Hospital, Zhejiang University, School of Medicine, Hangzhou, Zhejiang, China
| | - Qiong Luo
- Department of Obstetrics, Women's Hospital, Zhejiang University, School of Medicine, Hangzhou, Zhejiang, China
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Ulfsdottir H, Grandahl M, Björk J, Karlemark S, Ekéus C. The association between pre-eclampsia and neonatal complications in relation to gestational age. Acta Paediatr 2024; 113:426-433. [PMID: 38140818 DOI: 10.1111/apa.17080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 12/13/2023] [Accepted: 12/15/2023] [Indexed: 12/24/2023]
Abstract
AIM There has been limited research about the associations between pre-eclampsia and neonatal complications in relation to gestational age. This register-based study aimed to address that gap in our knowledge. METHODS We used Swedish Medical Birth Register to carry out a population-based study on primiparas with singleton pregnancies from 1999 to 2017. Descriptive statistics and logistic regressions were used to study the associations between pre-eclampsia and neonatal complications in different gestational ages. The data is presented as adjusted odds ratios (aORs) with 95% CI. RESULTS The study comprised 805 591 primiparas: 2.9% had mild to moderate pre-eclampsia and 1.4% had severe pre-eclampsia. Neonates born to women with pre-eclampsia had increased risks of several complications compared to those born to mothers without pre-eclampsia. After adjustment for confounding variables, the risk of being small for gestational age (aOR 5.3, CI: 5.1-5.5) and needing resuscitation (aOR 2.6, CI: 2.4-2.7) were increased. The risk of a low Apgar score and convulsions/hypoxic ischemic encephalopathy was increased at 32-41 weeks of gestation. Moreover, the overall risk of sepsis (aOR 1.9. CI: 1.8-2.1) and perinatal death (aOR 1.2, CI: 1.1-1.5) was also increased. CONCLUSION Compared with infants of mothers without pre-eclampsia, those exposed to pre-eclampsia had higher risks of all the studied neonatal complications.
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Affiliation(s)
- Hanna Ulfsdottir
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Maria Grandahl
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Johanna Björk
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Sara Karlemark
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Cecilia Ekéus
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Bayoumi RR, Hurt L, Zhang N, Law YJ, Venetis C, Fatem HM, Serour GI, van der Poel S, Boivin J. A critical systematic review and meta-analyses of risk factors for fertility problems in a globalized world. Reprod Biomed Online 2024; 48:103217. [PMID: 38244345 DOI: 10.1016/j.rbmo.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 04/11/2023] [Indexed: 01/22/2024]
Abstract
Globally, fertility awareness efforts include well-established risk factors for fertility problems. Risks disproportionately affecting women in the Global South, however, are neglected. To address this gap, we conducted a systematic review and meta-analyses of relevant risk factors to examine the association between risk factors and fertility problems. MEDLINE, Embase, Cochrane Library, regional databases and key organizational websites were used. Three authors screened and extracted data independently. Studies assessing exposure to risk (clinical, community-based samples) were included, and studies without control groups were excluded. Outcome of interest was fertility problems, e.g. inability to achieve pregnancy, live birth, neonatal death depending on study. The Newcastle-Ottawa Scale was used to assess study quality. A total of 3843 studies were identified, and 62 were included (58 in meta-analyses; n = 111,977). Results revealed the following: a ninefold risk of inability to become pregnant in genital tuberculosis (OR 8.91, 95% CI 1.89 to 42.12); an almost threefold risk in human immunodeficiency virus (OR 2.93, 95% CI 1.95 to 4.42) and bacterial vaginosis (OR 2.81, 95% CI 1.85 to 4.27); a twofold risk of tubal-factor infertility in female genital mutilation/cutting-Type II/III (OR 2.06, 95% CI 1.03 to 4.15); and postnatal mortality in consanguinity (stillbirth, OR 1.28, 95% CI 1.04 to 1.57; neonatal death, OR 1.57, 95% CI 1.22 to 2.02). It seems that risk factors affected reproductive processes through multiple pathways. Health promotion encompassing relevant health indicators could enhance prevention and early detection of fertility problems in the Global South and disproportionately affected populations. The multifactorial risk profile reinforces the need to place fertility within global health initiatives.
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Affiliation(s)
| | - Lisa Hurt
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, Wales, UK
| | - Ning Zhang
- Department of Obstetrics and Gynaecology, Royal North Shore Hospital, Sydney, Australia
| | - Yin Jun Law
- Department of Obstetrics and Gynaecology, The Canberra Hospital, Australian Capital Territory, Australia
| | - Christos Venetis
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | | | | | | | - Jacky Boivin
- School of Psychology, Cardiff University, Cardiff, Wales, UK.
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Sium AF, Bekele D, Urgie T, Gebremedhin G, Gudu W, Fetene A. Umbilical cord prolapse in a sub-Saharan setting: Incidence and perinatal mortality rate-A 4-year retrospective review. Int J Gynaecol Obstet 2024; 164:1220-1221. [PMID: 37927143 DOI: 10.1002/ijgo.15233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/14/2023] [Accepted: 10/12/2023] [Indexed: 11/07/2023]
Abstract
SynopsisPerinatal morality due to umbilical cord prolapse found in our study is comparable to that in high‐income settings.
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Affiliation(s)
- Abraham Fessehaye Sium
- Department of Obstetrics and Gynecology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Delayehu Bekele
- Department of Obstetrics and Gynecology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Tadesse Urgie
- Department of Obstetrics and Gynecology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Genet Gebremedhin
- Department of Obstetrics and Gynecology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Wondimu Gudu
- Department of Obstetrics and Gynecology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Awoke Fetene
- Department of Obstetrics and Gynecology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
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Sandoval GJ, Grobman WA, Evans SR, Rice MM, Clifton RG, Chauhan SP, Costantine MM, Gibson KS, Longo M, Metz TD, Miller ES, Parry S, Reddy UM, Rouse DJ, Simhan HN, Thorp JM, Tita ATN, Saade GR. Desirability of outcome ranking for obstetrical trials: illustration and application to the ARRIVE trial. Am J Obstet Gynecol 2024; 230:370.e1-370.e12. [PMID: 37741532 PMCID: PMC10939984 DOI: 10.1016/j.ajog.2023.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/31/2023] [Accepted: 09/06/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND In randomized trials, 1 primary outcome is typically chosen to evaluate the consequences of an intervention, whereas other important outcomes are relegated to secondary outcomes. This issue is amplified for many obstetrical trials in which an intervention may have consequences for both the pregnant person and the child. In contrast, desirability of outcome ranking, a paradigm shift for the design and analysis of clinical trials based on patient-centric evaluation, allows multiple outcomes-including from >1 individual-to be considered concurrently. OBJECTIVE This study aimed to describe desirability of outcome ranking methodology tailored to obstetrical trials and to apply the methodology to maternal-perinatal paired (dyadic) outcomes in which both individuals may be affected by an intervention but may experience discordant outcomes (eg, an obstetrical intervention may improve perinatal but worsen maternal outcomes). STUDY DESIGN This secondary analysis applies the desirability of outcome ranking methodology to data from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network ARRIVE trial. The original analysis found no substantial difference in the primary (perinatal composite) outcome, but a decreased risk of the secondary outcome of cesarean delivery with elective induction at 39 weeks. In the present desirability-of-outcome-ranking analysis, dyadic outcomes ranging from spontaneous vaginal delivery without severe neonatal complication (most desirable) to cesarean delivery with perinatal death (least desirable) were classified into 8 categories ranked by overall desirability by experienced investigators. Distributions of the desirability of outcome ranking were compared by estimating the probability of having a more desirable dyadic outcome with elective induction at 39 weeks of gestation than with expectant management. To account for various perspectives on these outcomes, a complementary analysis, called the partial credit strategy, was used to grade outcomes on a 100-point scale and estimate the difference in overall treatment scores between groups using a t test. RESULTS All 6096 participants from the trial were included. The probability of a better dyadic outcome for a randomly selected patient who was randomized to elective induction was 53% (95% confidence interval, 51-54), implying that elective induction led to a better overall outcome for the dyad when taking multiple outcomes into account concurrently. Furthermore, the desirability-of-outcome-ranking probability of averting cesarean delivery with elective induction was 52% (95% confidence interval, 51-53), which was not at the expense of an operative vaginal delivery or a poorer outcome for the perinate (ie, survival with a severe neonatal complication or perinatal death). Randomization to elective induction was also advantageous in most of the partial credit score scenarios. CONCLUSION Desirability-of-outcome-ranking methodology is a useful tool for obstetrical trials because it provides a concurrent view of the effect of an intervention on multiple dyadic outcomes, potentially allowing for better translation of data for decision-making and person-centered care.
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Affiliation(s)
| | - William A Grobman
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL
| | - Scott R Evans
- Biostatistics Center, George Washington University, Washington, DC
| | - Madeline M Rice
- Biostatistics Center, George Washington University, Washington, DC
| | | | - Suneet P Chauhan
- Department of Obstetrics and Gynecology, University of Texas Health Science Center at Houston, Children's Memorial Hermann Hospital, Houston, TX
| | - Maged M Costantine
- Department of Obstetrics and Gynecology, Ohio State University, Columbus, OH
| | - Kelly S Gibson
- Department of Obstetrics and Gynecology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH
| | - Monica Longo
- the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD
| | - Torri D Metz
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, UT
| | - Emily S Miller
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL
| | - Samuel Parry
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA
| | - Uma M Reddy
- Department of Obstetrics and Gynecology, Columbia University, New York, NY
| | - Dwight J Rouse
- Department of Obstetrics and Gynecology, Brown University, Providence, RI
| | - Hyagriv N Simhan
- Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, PA
| | - John M Thorp
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Alan T N Tita
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL
| | - George R Saade
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX
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Pergialiotis V, Sapantzoglou I, Rodolaki K, Varthaliti A, Theodora M, Antsaklis P, Thomakos N, Stavros S, Daskalakis G, Papapanagiotou A. Maternal and neonatal outcomes following magnesium sulfate in the setting of chorioamnionitis: a meta-analysis. Arch Gynecol Obstet 2024; 309:917-927. [PMID: 37768342 PMCID: PMC10866770 DOI: 10.1007/s00404-023-07221-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/01/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE Magnesium sulfate (MgSO4) has been widely used in obstetrics as a mean to help decrease maternal and neonatal morbidity in various antenatal pathology. As a factor, it seems to regulate immunity and can, thus, predispose to infectious morbidity. To date, it remains unknown if its administration can increase the risk of chorioamnionitis. In the present meta-analysis, we sought to accumulate the available evidence. METHODS We systematically searched Medline, Scopus, Clinicaltrials.gov, EMBASE, Cochrane Central Register of Controlled Trials CENTRAL, and Google Scholar databases in our primary search along with the reference lists of electronically retrieved full-text papers. RESULTS Eight studies were included that investigated the incidence of chorioamnionitis among parturient that received MgSO4 and control patients. Magnesium sulfate was administered in 3229 women and 3330 women served as controls as they did not receive MgSO4. The meta-analysis of data revealed that there was no association between the administration of magnesium sulfate and the incidence of chorioamnionitis (OR 0.98, 95% CI 0.73, 1.32). Rucker's analysis revealed that small studies did not significantly influence the statistical significance of this finding (OR 1.12, 95% CI 0.82, 1.53). Trial sequential analysis revealed that the required number to safely interpret the primary outcome was not reached. Two studies evaluated the impact of MgSO4 in neonates delivered in the setting of chorioamnionitis. Neither of these indicated the presence of a beneficial effect in neonatal morbidity, including the risk of cerebral palsy, intraventricular hemorrhage, necrotizing enterocolitis, bronchopulmonary dysplasia, sepsis, stillbirth, or neonatal death. CONCLUSION Current evidence indicates that magnesium sulfate is not associated with an increased risk of maternal chorioamnionitis. However, it should be noted that its effect on neonatal outcomes of offspring born in the setting of chorioamnionitis might be subtle if any, although the available evidence is very limited.
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Affiliation(s)
- Vasilios Pergialiotis
- First Department of Obstetrics and Gynecology, "Alexandra" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioakim Sapantzoglou
- First Department of Obstetrics and Gynecology, "Alexandra" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Kalliopi Rodolaki
- First Department of Obstetrics and Gynecology, "Alexandra" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Antonia Varthaliti
- First Department of Obstetrics and Gynecology, "Alexandra" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Marianna Theodora
- First Department of Obstetrics and Gynecology, "Alexandra" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Antsaklis
- First Department of Obstetrics and Gynecology, "Alexandra" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Thomakos
- First Department of Obstetrics and Gynecology, "Alexandra" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Sofoklis Stavros
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Daskalakis
- First Department of Obstetrics and Gynecology, "Alexandra" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Aggeliki Papapanagiotou
- Third Department of Obstetrics and Gynecology, Attikon General Hospital, National and Kapodistrian University of Athens, 2, Lourou Str., 11523, Athens, Greece.
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Kuforiji O, Mills TA, Lovell K. An exploration of women's lived experiences of care and support following perinatal death in South-Western Nigeria: A hermeneutic phenomenological study. Women Birth 2024; 37:348-354. [PMID: 38030416 DOI: 10.1016/j.wombi.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 11/14/2023] [Accepted: 11/17/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Perinatal death results in long-lasting intense grief for bereaved mothers with a potential to negatively impact on their short- and long-term outcomes and quality of life if inadequately supported in coping with and managing their experience. AIM This study aimed at exploring the lived experience of women, of care and support following perinatal death in South-Western, Nigeria. METHODS A qualitative methodology using Heideggerian phenomenology was used. Fourteen women who had experienced perinatal death in South-Western Nigeria within the last (5) five years were interviewed, and Van Manen's approach to hermeneutic phenomenology was used in data analysis. FINDINGS Four main themes were identified: "they did not tell me the baby died", "response of health care professionals after the baby died", "moving on from hospital", and "support from family". The physical health status of mothers determined how they were informed of perinatal death. Health care professionals were distant, rude, nonempathetic and did not offer emotional support, in some cases. Mothers were given opportunity to see and hold their babies. There was no routine follow-up support in the community, besides a postnatal check-up appointment offered to all mothers regardless of their birth outcome. Family provided emotional support for mothers on discharge. CONCLUSION This study was the first to explore the lived experience of women of the care and support following perinatal death in South-Western, Nigeria. There is a need for healthcare systems to review bereavement care and support provisions for women who experience perinatal death.
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Affiliation(s)
- Omotewa Kuforiji
- Faculty of Biology, Medicine and Health, The University of Manchester, Jean McFarlane Building, Oxford Road, Manchester M13 9PL, United Kingdom.
| | - Tracey A Mills
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Karina Lovell
- Faculty of Biology, Medicine and Health, The University of Manchester, Jean McFarlane Building, Oxford Road, Manchester M13 9PL, United Kingdom
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Andrioli Peralta CF, Jorge Rodrigues da Costa K, Peneluppi Horak AC, Pinheiro do Carmo Gomes S, Sousa Santos E, Galvão Barbante L, Hideo Nakagawa Santos R. Predictors of fetal death, neonatal survival and neurological outcomes in severe twin-twin transfusion syndrome treated by laser ablation of placental vessels. Prenat Diagn 2024; 44:325-335. [PMID: 38243614 DOI: 10.1002/pd.6523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 11/06/2023] [Accepted: 11/17/2023] [Indexed: 01/21/2024]
Abstract
OBJECTIVES To identify predictors of outcomes in severe twin oligo-polyhydramnios sequence (TOPS) with or without twin anemia-polycythemia sequence (TAPS) and/or selective fetal growth restriction (SFGR) treated by laser ablation of placental vessels (LAPV). METHODS Analysis of cases treated from 2011 to 2022. Variables evaluated Prenatal predictors: stages of TOPS, presence of TAPS and/or SFGR; pre-LAPV fetal ultrasound parameters; peri-LAPV variables. Perinatal predictors: GA at birth; birthweight; Apgar scores; transfontanellar ultrasonography (TFUS). OUTCOME VARIABLES fetal death, neonatal survival, infant's neurodevelopment. Binary logistic regression analyses were performed to detect predictors of outcomes. RESULTS 265 cases were included. Predictors of post-LAPV donor fetus' death were delta EFW (p:0.045) and absent/reverse end-diastolic flow in the umbilical artery (AREDF-UA) (p < 0.001). The predictor of post-LAPV recipient fetus' death was hydrops (p:0.009). Predictors of neonatal survival were GA at birth and Apgar scores. Predictors of infant's neurodevelopment were TFUS and pre-LAPV middle cerebral artery Doppler (MCAD) for the donor twin; and pre-LAPV ductus venosus' flow and MCAD for the recipient twin. CONCLUSIONS Prediction of fetal death, neonatal survival and infant's neurodevelopment is possible in cases of TOPS associated or not with SFGR and/or TAPS that were treated by LAPV.
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Affiliation(s)
- Cleisson Fábio Andrioli Peralta
- Fetal Medicine Unit, Heart Hospital (HCor), São Paulo, São Paulo, Brazil
- Fetal Medicine and Surgery Center (Gestar), São Paulo, São Paulo, Brazil
- Research Institute (HCor), São Paulo, São Paulo, Brazil
| | - Karina Jorge Rodrigues da Costa
- Fetal Medicine Unit, Heart Hospital (HCor), São Paulo, São Paulo, Brazil
- Fetal Medicine and Surgery Center (Gestar), São Paulo, São Paulo, Brazil
- Research Institute (HCor), São Paulo, São Paulo, Brazil
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Koray MH, Curry T. Predictors of perinatal mortality in Liberia's post-civil unrest: A comparative analysis of the 2013 and 2019-2020 Liberia Demographic and Health Surveys. BMJ Open 2024; 14:e080661. [PMID: 38417962 PMCID: PMC10900345 DOI: 10.1136/bmjopen-2023-080661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2024] Open
Abstract
INTRODUCTION Perinatal mortality remains a pressing concern, especially in lower and middle-income nations. Globally, 1 in 72 babies are stillborn. Despite advancements, the 2030 targets are challenging, notably in sub-Saharan Africa. Post-war Liberia saw a 14% spike in perinatal mortality between 2013 and 2020, indicating the urgency for in-depth study. OBJECTIVE The study aims to investigate the predictors of perinatal mortality in Liberia using 2013 and 2019-2020 Liberia Demographic and Health Survey datasets. METHODS In a two-stage cluster design from the Liberia Demographic and Health Survey, 6572 and 5285 respondents were analysed for 2013 and 2019-2020, respectively. Data included women aged 15-49 with pregnancy histories. Descriptive statistics was used to analyse the sociodemographic characteristics, the exposure to media and the maternal health services. Bivariate and multivariate logistic regressions were used to examine the predictors of perinatal mortality at a significance level of p value ≤0.05 and 95% CI. The data analysis was conducted in STATA V.14. RESULTS Perinatal mortality rates increased from 30.23 per 1000 births in 2013 to 42.05 in 2019-2020. In 2013, increasing age of respondents showed a reduced risk of perinatal mortality rate. In both years, having one to three children significantly reduced mortality risk (2013: adjusted OR (aOR) 0.30, 95% CI 0.14 to 0.64; 2019: aOR 0.24, 95% CI 0.11 to 0.54), compared with not having a child. Weekly radio listenership increased mortality risk (2013: aOR 1.36, 95% CI 0.99 to 1.89; 2019: aOR 1.86, 95% CI 1.35 to 2.57) compared with not listening at all. Longer pregnancy intervals (p<0.0001) and receiving 2+ tetanus injections (p=0.019) were protective across both periods. However, iron supplementation showed varied effects, reducing risk in 2013 (aOR 0.90, 95% CI 0.48 to 1.68) but increasing it in 2019 (aOR 2.10, 95% CI 0.90 to 4.92). CONCLUSION The study reports an alarming increase in Liberia's perinatal mortality from 2013 to 2019-2020. The findings show dynamic risk factors necessitating adaptable healthcare approaches, particularly during antenatal care. These adaptable approaches are crucial for refining health strategies in line with the Sustainable Development Goals, with emphasis on the integration of health, education, gender equality, sustainable livelihoods and global partnerships for effective health outcomes.
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Affiliation(s)
| | - Tanya Curry
- National Public Health Institute of Liberia, Monrovia, Liberia
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Min L, Mao Y, Lai H. Burden of silica-attributed pneumoconiosis and tracheal, bronchus & lung cancer for global and countries in the national program for the elimination of silicosis, 1990-2019: a comparative study. BMC Public Health 2024; 24:571. [PMID: 38388421 PMCID: PMC10885413 DOI: 10.1186/s12889-024-18086-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 02/13/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND In industries worldwide, crystalline silica is pervasive and poses risks of pneumoconiosis and respiratory malignancies, with the latter being a knowledge gap in disease burden research that this study aims to address. By integrating both diseases, we also seek to provide an in-depth depiction of the silica-attributed disease burden. METHODS Data from the Global Burden of Disease 2019 were extracted to analyze the disease burden due to silica exposure. The trends of age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR) from 1990 to 2019, as well as the age-specific number and rate of deaths and disability-adjusted life years (DALYs) in 1990 and 2019, were presented using GraphPad Prism software. The average annual percentage changes (AAPCs) on ASMR and ASDR were calculated using joinpoint regression models. RESULTS The global trends of disease burden due to silica exposure from 1990 to 2019 showed a significant decrease, with AAPCs on ASMR and ASDR of -1.22 (-1.38, -1.06) and - 1.18 (-1.30, -1.05), respectively. Vietnam was an exception with an unprecedented climb in ASMR and ASDR in general over the years. The age-specific deaths and DALYs mainly peaked in the age group 60-64. In comparison to 1990, the number of deaths and DALYs became higher after 45 years old in 2019, while their rates stayed consistently lower in 2019. Males experienced an elevated age-specific burden than females. China's general age-standardized burden of pneumoconiosis and tracheal, bronchus & lung (TBL) cancer ranked at the forefront, along with the highest burden of pneumoconiosis in Chilean males and South African females, as well as the prominent burden of TBL cancer in Turkish males, Thai females, and overall Vietnamese. The age-specific burden of TBL cancer surpassed that of pneumoconiosis, and a delay was presented in the pneumoconiosis pinnacle burden compared to the TBL cancer. Besides, the burden of pneumoconiosis indicated a sluggish growth trend with advancing age. CONCLUSION Our research highlights the cruciality of continuous enhancements in occupational health legislation for countries seriously suffering from industrial silica pollution and the necessity of prioritizing preventive measures for male workers and elderly retirees.
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Affiliation(s)
- Lingfeng Min
- Department of Respiratory and Critical Care Medicine, Northern Jiangsu People's Hospital, 225009, Yangzhou, China
| | - Yiyang Mao
- Department of Occupational Health, Yangzhou Center for Disease Control and Prevention, 225001, Yangzhou, China
| | - Hanpeng Lai
- Department of Occupational and Environmental Health, School of Public Health, Yangzhou University, 225009, Yangzhou, China.
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Lv H, Zhang X, Zhang X, Bai J, You S, Li X, Li S, Wang Y, Zhang W, Xu Y. Global prevalence and burden of multidrug-resistant tuberculosis from 1990 to 2019. BMC Infect Dis 2024; 24:243. [PMID: 38388352 PMCID: PMC10885623 DOI: 10.1186/s12879-024-09079-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 01/31/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Tuberculosis(TB) remains a pressing public health challenge, with multidrug-resistant tuberculosis (MDR-TB) emerging as a major threat. And healthcare authorities require reliable epidemiological evidence as a crucial reference to address this issue effectively. The aim was to offer a comprehensive epidemiological assessment of the global prevalence and burden of MDR-TB from 1990 to 2019. METHODS Estimates and 95% uncertainty intervals (UIs) for the age-standardized prevalence rate (ASPR), age-standardized incidence rate (ASIR), age-standardized disability-adjusted life years rate (ASR of DALYs), and age-standardized death rate (ASDR) of MDR-TB were obtained from the Global Burden of Disease (GBD) 2019 database. The prevalence and burden of MDR-TB in 2019 were illustrated in the population and regional distribution. Temporal trends were analyzed by using Joinpoint regression analysis to calculate the annual percentage change (APC), average annual percentage change (AAPC) and its 95% confidence interval(CI). RESULTS The estimates of the number of cases were 687,839(95% UIs: 365,512 to 1223,262), the ASPR were 8.26 per 100,000 (95%UIs: 4.61 to 15.20), the ASR of DALYs were 52.38 per 100,000 (95%UIs: 22.64 to 97.60) and the ASDR were 1.36 per 100,000 (95%UIs: 0.54 to 2.59) of MDR-TB at global in 2019. Substantial burden was observed in Africa and Southeast Asia. Males exhibited higher ASPR, ASR of DALYs, and ASDR than females across most age groups, with the burden of MDR-TB increasing with age. Additionally, significant increases were observed globally in the ASIR (AAPC = 5.8; 95%CI: 5.4 to 6.1; P < 0.001), ASPR (AAPC = 5.9; 95%CI: 5.4 to 6.4; P < 0.001), ASR of DALYs (AAPC = 4.6; 95%CI: 4.2 to 5.0; P < 0.001) and ASDR (AAPC = 4.4; 95%CI: 4.0 to 4.8; P < 0.001) of MDR-TB from 1990 to 2019. CONCLUSIONS This study underscored the persistent threat of drug-resistant tuberculosis to public health. It is imperative that countries and organizations worldwide take immediate and concerted action to implement measures aimed at significantly reducing the burden of TB.
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Affiliation(s)
- Hengliang Lv
- Department of Epidemiology, School of Public Health, China Medical University, Shenyang, China
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Xin Zhang
- Department of Epidemiology, School of Public Health, China Medical University, Shenyang, China
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Xueli Zhang
- Changchun University of Chinese Medicine, Changchun, China
| | - Junzhu Bai
- Department of Epidemiology, School of Public Health, China Medical University, Shenyang, China
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Shumeng You
- Department of Epidemiology, School of Public Health, China Medical University, Shenyang, China
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Xuan Li
- Department of Epidemiology, School of Public Health, China Medical University, Shenyang, China
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Shenlong Li
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Yong Wang
- Department of Epidemiology, School of Public Health, China Medical University, Shenyang, China
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Wenyi Zhang
- Department of Epidemiology, School of Public Health, China Medical University, Shenyang, China.
- Chinese PLA Center for Disease Control and Prevention, Beijing, China.
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China.
| | - Yuanyong Xu
- Department of Epidemiology, School of Public Health, China Medical University, Shenyang, China.
- Chinese PLA Center for Disease Control and Prevention, Beijing, China.
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Rial-Crestelo M, Lubusky M, Parra-Cordero M, Krofta L, Kajdy A, Zohav E, Ferriols-Perez E, Cruz-Martinez R, Kacerovsky M, Scazzocchio E, Roubalova L, Socias P, Hašlík L, Modzelewski J, Ashwal E, Castellá-Cesari J, Cruz-Lemini M, Gratacos E, Figueras F. Term planned delivery based on fetal growth assessment with or without the cerebroplacental ratio in low-risk pregnancies (RATIO37): an international, multicentre, open-label, randomised controlled trial. Lancet 2024; 403:545-553. [PMID: 38219773 DOI: 10.1016/s0140-6736(23)02228-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 09/07/2023] [Accepted: 10/03/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND The cerebroplacental ratio is associated with perinatal mortality and morbidity, but it is unknown whether routine measurement improves pregnancy outcomes. We aimed to evaluate whether the addition of cerebroplacental ratio measurement to the standard ultrasound growth assessment near term reduces perinatal mortality and severe neonatal morbidity, compared with growth assessment alone. METHODS RATIO37 was a randomised, open-label, multicentre, pragmatic trial, conducted in low-risk pregnant women, recruited from nine hospitals over six countries. The eligibility criteria were designed to be broad; participants were required to be 18 years or older, with an ultrasound-dated confirmed singleton pregnancy in the first trimester, an alive fetus with no congenital malformations at the routine second-trimester ultrasound, an absence of adverse medical or obstetric history, and the capacity to give informed consent. Women were randomly assigned in a 1:1 ratio (block size 100) using a web-based system to either the concealed group or revealed group. In the revealed group, the cerebroplacental ratio value was known by clinicians, and if below the fifth centile, a planned delivery after 37 weeks was recommended. In the concealed group, women and clinicians were blinded to the cerebroplacental ratio value. All participants underwent ultrasound at 36 + 0 to 37 + 6 weeks of gestation with growth assessment and Doppler evaluation. In both groups, planned delivery was recommended when the estimated fetal weight was below the tenth centile. The primary outcome was perinatal mortality from 24 weeks' gestation to infant discharge. The study is registered at ClinicalTrials.gov (NCT02907242) and is now closed. FINDINGS Between July 29, 2016, and Aug 3, 2021, we enrolled 11 214 women, of whom 9492 (84·6%) completed the trial and were eligible for analysis (4774 in the concealed group and 4718 in the revealed group). Perinatal mortality occurred in 13 (0·3%) of 4774 pregnancies in the concealed group and 13 (0·3%) of 4718 in the revealed group (OR 1·45 [95% CI 0·76-2·76]; p=0·262). Overall, severe neonatal morbidity occurred in 35 (0·73%) newborns in the concealed group and 18 (0·38%) in the revealed group (OR 0·58 [95% CI 0·40-0·83]; p=0·003). Severe neurological morbidity occurred in 13 (0·27%) newborns in the concealed group and nine (0·19%) in the revealed group (OR 0·56 [95% CI 0·25-1·24]; p=0·153). Severe non-neurological morbidity occurred in 23 (0·48%) newborns in the concealed group and nine (0·19%) in the revealed group (0·58 [95% CI 0·39-0·87]; p=0·009). Maternal adverse events were not collected. INTERPRETATION Planned delivery at term based on ultrasound fetal growth assessment and cerebroplacental ratio at term was not followed by a reduction of perinatal mortality although significantly reduced severe neonatal morbidity compared with fetal growth assessment alone. FUNDING La Caixa foundation, Cerebra Foundation for the Brain Injured Child, Agència per la Gestió d'Ajuts Universitaris i de Recerca, and Instituto de Salud Carlos III.
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Affiliation(s)
- Marta Rial-Crestelo
- BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital San Joan de Deu, Barcelona, Spain
| | - Marek Lubusky
- The Fetal Medicine Center, Department of Obstetrics and Gynecology Palacky University Hospital, Olomouc, Czech Republic
| | - Mauro Parra-Cordero
- Maternal Fetal Medicine Unit, Department of Obstetrics and Gynecology, University of Chile Hospital, Santiago, Chile
| | - Ladislav Krofta
- Institute for the Care of Mother and Child, the Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Anna Kajdy
- First Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Eyal Zohav
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Obstetrics and Gynecology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Elena Ferriols-Perez
- Obstetrics and Gynecology Consorci Parc de Salut Mar, Hospital del Mar, Barcelona, Spain
| | - Rogelio Cruz-Martinez
- Fetal Medicine Department, Instituto Medicina Fetal México, Children and Women's Specialty Hospital of Querétaro, Querétaro, Mexico
| | - Marian Kacerovsky
- University Hospital Hradec Kralove, Charles University, Faculty of Medicine, Hradec Kralove, Czech Republic
| | - Elena Scazzocchio
- Atencio a la Salut Sexual i Reproductiva (ASSIR) de Barcelona, Primary Care Center, Catalan Institut of Health, Barcelona, Spain
| | - Lucie Roubalova
- The Fetal Medicine Center, Department of Obstetrics and Gynecology Palacky University Hospital, Olomouc, Czech Republic
| | - Pamela Socias
- Maternal Fetal Medicine Unit, Department of Obstetrics and Gynecology, University of Chile Hospital, Santiago, Chile
| | - Lubomir Hašlík
- Institute for the Care of Mother and Child, the Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jan Modzelewski
- First Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Eran Ashwal
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Obstetrics and Gynecology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Julia Castellá-Cesari
- Obstetrics and Gynecology Consorci Parc de Salut Mar, Hospital del Mar, Barcelona, Spain
| | - Monica Cruz-Lemini
- Maternal Fetal Medicine Department, Hospital de Especialidades del Niño y la Mujer, Dr Felipe Nuñez Lara, Querétaro, Mexico
| | - Eduard Gratacos
- BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital San Joan de Deu, Barcelona, Spain
| | - Francesc Figueras
- BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital San Joan de Deu, Barcelona, Spain.
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Derbew AA, Debeb HG, Kinsman J, Myléus A, Byass P. Assessing the performance of the family folder system for collecting community-based health information in Tigray Region, North Ethiopia: a capture-recapture study. BMJ Open 2024; 14:e067735. [PMID: 38331856 PMCID: PMC10860088 DOI: 10.1136/bmjopen-2022-067735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 07/04/2023] [Indexed: 02/10/2024] Open
Abstract
OBJECTIVES To assess completeness and accuracy of the family folder in terms of capturing community-level health data. STUDY DESIGN A capture-recapture method was applied in six randomly selected districts of Tigray Region, Ethiopia. PARTICIPANTS Child health data, abstracted from randomly selected 24 073 family folders from 99 health posts, were compared with similar data recaptured through household survey and routine health information made by these health posts. PRIMARY AND SECONDARY OUTCOME MEASURES Completeness and accuracy of the family folder data; and coverage selected child health indicators, respectively. RESULTS Demographic data captured by the family folders and household survey were highly concordant, concordance correlation for total population, women 15-49 years age and under 5-year child were 0.97 (95% CI 0.94 to 0.99, p<0.001), 0.73 (95% CI 0.67 to 0.88) and 0.91 (95% CI 0.85 to 0.96), respectively. However, the live births, child health service indicators and child health events were more erratically reported in the three data sources. The concordance correlation among the three sources, for live births and neonatal deaths was 0.094 (95% CI -0.232 to 0.420) and 0.092 (95% CI -0.230 to 0.423) respectively, and for the other parameters were close to 0. CONCLUSION The family folder system comprises a promising development. However, operational issues concerning the seamless capture and recording of events and merging community and facility data at the health centre level need improvement.
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Affiliation(s)
- Atakelti Abraha Derbew
- Ministry of Health, Addis Ababa, Ethiopia
- Department of health promotion and disease prevention, Tigray Health Bureau, Mekelle, Tigray, Ethiopia
| | | | - John Kinsman
- Department for Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Anna Myléus
- Department for Epidemiology and Global Health, Umeå University, Umeå, Sweden
- Family Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umea, Sweden
| | - Peter Byass
- Department for Epidemiology and Global Health, Umeå University, Umeå, Sweden
- Umeå Centre for Global Health Research, Umea Universitet, Umeå, Sweden
- MRC-Wits Rural Public Health and Health Transitions Research, University of the Witwatersrand Johannesburg Faculty of Health Sciences, Johannesburg, Gauteng, South Africa
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Lin J, Zhang K, Wu F, Wang B, Chai W, Zhu Q, Huang J, Lin J. Maternal and perinatal risks for monozygotic twins conceived following frozen-thawed embryo transfer: a retrospective cohort study. J Ovarian Res 2024; 17:36. [PMID: 38326864 PMCID: PMC10848471 DOI: 10.1186/s13048-024-01349-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 01/11/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND The present study aimed to explore the maternal and perinatal risks in cases of monozygotic twins (MZT) following frozen-thawed embryo transfer (FET). METHODS All twin births that were conceived following FET from 2007 to 2021 at Shanghai Ninth People's Hospital in Shanghai, China were retrospectively reviewed. The exposure variable was twin type (monozygotic and dizygotic). The primary outcome was the incidence of neonatal death while secondary outcomes included hypertensive disorders of pregnancy, gestational diabetes, intrahepatic cholestasis of pregnancy, placenta previa, placental abruption, preterm premature rupture of the membranes, Cesarean delivery, gestational age, birth weight, weight discordance, stillbirth, birth defects, pneumonia, respiratory distress syndrome, necrotizing enterocolitis, and neonatal jaundice. Analysis of the outcomes was performed using logistic regression models to estimate odds ratios (ORs) and 95% confidence intervals (CIs). The causal mediation analysis was conducted. A doubly robust estimation model was used to validate the results. Kaplan-Meier method was used to calculate survival probability. The sensitivity analysis was performed with a propensity score-based patient-matching model. RESULTS Of 6101 dizygotic twin (DZT) and 164 MZT births conceived by FET, MZT showed an increased risk of neonatal death based on the multivariate logistic regression models (partially adjusted OR: 4.19; 95% CI, 1.23-10.8; fully adjusted OR: 4.95; 95% CI, 1.41-13.2). Similar results were obtained with the doubly robust estimation. Comparing MZT with DZT, the neonatal survival probability was lower for MZT (P < 0.05). The results were robust in the sensitivity analysis. Females with MZT pregnancies exhibited an elevated risk of preterm premature rupture of the membranes (adjusted OR: 2.42; 95% CI, 1.54-3.70). MZT were also associated with higher odds of preterm birth (prior to 37 weeks) (adjusted OR: 2.31; 95% CI, 1.48-3.67), low birth weight (adjusted OR: 1.92; 95% CI, 1.27-2.93), and small for gestational age (adjusted OR: 2.18; 95% CI, 1.21-3.69) in the fully adjusted analyses. The effect of MZT on neonatal death was partially mediated by preterm birth and low birth weight (P < 0.05). CONCLUSIONS This study indicates that MZT conceived by FET are related to an increased risk of neonatal death, emphasizing a potential need for comprehensive antenatal surveillance in these at-risk pregnancies.
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Affiliation(s)
- Jing Lin
- Center for Reproductive Medicine, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Kai Zhang
- Department of Hepatobiliary Surgery, National Clinical Research Center for Cancer / Cancer Hospital, National Cancer Center, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, 100021, China
| | - Fenglu Wu
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Zhizaoju Road No. 639, Shanghai, 200011, China
| | - Bian Wang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Zhizaoju Road No. 639, Shanghai, 200011, China
| | - Weiran Chai
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Zhizaoju Road No. 639, Shanghai, 200011, China
| | - Qianqian Zhu
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Zhizaoju Road No. 639, Shanghai, 200011, China
| | - Jialyu Huang
- Center for Reproductive Medicine, Jiangxi Maternal and Child Health Hospital, Nanchang University School of Medicine, 318 Bayi Avenue, Nanchang, 330006, China.
| | - Jiaying Lin
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Zhizaoju Road No. 639, Shanghai, 200011, China.
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Muwema M, Nankabirwa JI, Edwards G, Nalwadda G, Nangendo J, Okiring J, Obeng-Amoako GO, Mwanja W, Ekong EN, Kalyango JN, Kaye DK. Perinatal care and its association with perinatal death among women attending care in three district hospitals of western Uganda. BMC Pregnancy Childbirth 2024; 24:113. [PMID: 38321398 PMCID: PMC10845583 DOI: 10.1186/s12884-024-06305-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 01/29/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Provision of effective care to all women and newborns during the perinatal period is a viable strategy for achieving the Sustainable Development Goal 3 targets on reducing maternal and neonatal mortality. This study examined perinatal care (antenatal, intrapartum, postpartum) and its association with perinatal deaths at three district hospitals in Bunyoro region, Uganda. METHODS A cross-sectional study was conducted in which a questionnaire was administered consecutively to 872 postpartum women before discharge who had attended antenatal care and given birth in the study hospitals. Data on care received during antenatal, labour, delivery, and postpartum period, and perinatal outcome were extracted from medical records of the enrolled postnatal women using a pre-tested structured tool. The care received from antenatal to 24 h postpartum period was assessed against the standard protocol of care established by World Health Organization (WHO). Poisson regression was used to assess the association between care received and perinatal death. RESULTS The mean age of the women was 25 years (standard deviation [SD] 5.95). Few women had their blood tested for hemoglobin levels, HIV, and Syphilis (n = 53, 6.1%); had their urine tested for glucose and proteins (n = 27, 3.1%); undertook an ultrasound scan (n = 262, 30%); and had their maternal status assessed (n = 122, 14%) during antenatal care as well as had their uterus assessed for contraction and bleeding during postpartum care (n = 63, 7.2%). There were 19 perinatal deaths, giving a perinatal mortality rate of 22/1,000 births (95% Confidence interval [CI] 8.1-35.5). Of these 9 (47.4%) were stillbirths while the remaining 10 (52.6%) were early neonatal deaths. In the antenatal phase, only fetal examination was significantly associated with perinatal death (adjusted prevalence ratio [aPR] = 0.22, 95% CI 0.1-0.6). No significant association was found between perinatal deaths and care during labour, delivery, and the early postpartum period. CONCLUSION Women did not receive all the required perinatal care during the perinatal period. Perinatal mortality rate in Bunyoro region remains high, although it's lower than the national average. The study shows a reduction in the proportion of perinatal deaths for pregnancies where the mother received fetal monitoring. Strategies focused on strengthened fetal status monitoring such as fetal movement counting methods and fetal heart rate monitoring devices during pregnancy need to be devised to reduce the incidence of perinatal deaths. Findings from the study provide valuable information that would support the strengthening of perinatal care services for improved perinatal outcomes.
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Affiliation(s)
- Mercy Muwema
- Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
| | - Joaniter I Nankabirwa
- Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Grace Edwards
- School of Nursing and Midwifery, Aga Khan University, Kampala, Uganda
| | - Gorrette Nalwadda
- Department of Nursing, School of Health Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Joanita Nangendo
- Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Jaffer Okiring
- Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Gloria Odei Obeng-Amoako
- Department of Nutrition and Food Science, School of Biological Sciences, College of Basic and Applied Sciences, University of Ghana, Legon, Ghana
| | | | - Elizabeth N Ekong
- Department of Nursing and Midwifery, Faculty of Public Health, Nursing and Midwifery, Uganda Christian University, Mukono, Uganda
| | - Joan N Kalyango
- Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Pharmacy, School of Health Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Dan K Kaye
- Department of Obstetrics and Gynecology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
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Ariff S, Jiwani U, Rizvi A, Muhammad S, Hussain A, Ahmed I, Hussain M, Usman M, Iqbal J, Memon Z, Soofi SB, Bhutta ZA. Effect of Maternal and Newborn Care Service Package on Perinatal and Newborn Mortality: A Cluster Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2356609. [PMID: 38372998 PMCID: PMC10877450 DOI: 10.1001/jamanetworkopen.2023.56609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 12/27/2023] [Indexed: 02/20/2024] Open
Abstract
Importance In resource-constrained settings where the neonatal mortality rate (NMR) is high due to preventable causes and health systems are underused, community-based interventions can increase newborn survival by improving health care practices. Objectives To develop and evaluate the effectiveness of a community-based maternal and newborn care services package to reduce perinatal and neonatal mortality in rural Pakistan. Design, Setting, and Participants This cluster randomized clinical trial was conducted between November 1, 2012, and December 31, 2013, in district Rahim Yar Khan in the province of Punjab. A cluster was defined as an administrative union council. Any consenting pregnant resident of the study area, regardless of gestational age, was enrolled. An ongoing pregnancy surveillance system identified 12 529 and 12 333 pregnancies in the intervention and control clusters, respectively; 9410 pregnancies were excluded from analysis due to continuation of pregnancy at the end of the study, loss to follow-up, or miscarriage. Participants were followed up until the 40th postpartum day. Statistical analysis was performed from January to May 2014. Intervention A maternal and newborn health pack, training for community- and facility-based health care professionals, and community mobilization through counseling and education sessions. Main Outcomes and Measures The primary outcome was perinatal mortality, defined as stillbirths per 1000 births and neonatal death within 7 days per 1000 live births. The secondary outcome was neonatal mortality, defined as death within 28 days of life per 1000 live births. Systematic random sampling was used to allocate 10 clusters each to intervention and control groups. Analysis was conducted on a modified intention-to-treat basis. Results For the control group vs the intervention group, the total number of households was 33 188 vs 34 315, the median number of households per cluster was 3092 (IQR, 3018-3467) vs 3469 (IQR, 3019-4075), the total population was 229 155 vs 234 674, the mean (SD) number of residents per household was 6.9 (9.5) vs 6.8 (9.6), the number of males per 100 females (ie, the sex ratio) was 104.2 vs 103.7, and the mean (SD) number of children younger than 5 years per household was 1.0 (4.2) vs 1.0 (4.3). Altogether, 7598 births from conrol clusters and 8017 births from intervention clusters were analyzed. There was no significant difference in perinatal mortality between the intervention and control clusters (rate ratio, 0.86; 95% CI, 0.69-1.08; P = .19). The NMR was lower among the intervention than the control clusters (39.2/1000 live births vs 52.2/1000 live births; rate ratio, 0.75; 95% CI, 0.58-0.95; P = .02). The frequencies of antenatal visits and facility births were similar between the 2 groups. However, clean delivery practices were higher among intervention clusters than control clusters (63.2% [2284 of 3616] vs 13.2% [455 of 3458]; P < .001). Chlorhexidine use was also more common among intervention clusters than control clusters (55.9% [4271 of 7642] vs 0.3% [19 of 7203]; P < .001). Conclusions and Relevance This pragmatic cluster randomized clinical trial demonstrated a reduction in NMR that occurred in the background of improved household intrapartum and newborn care practices. However, the effect of the intervention on antenatal visits, facility births, and perinatal mortality rates was inconclusive, highlighting areas requiring further research. Nevertheless, the improvement in NMR underscores the effectiveness of community-based programs in low-resource settings. Trial Registration ClinicalTrials.gov Identifier: NCT01751945.
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Affiliation(s)
- Shabina Ariff
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Uswa Jiwani
- Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Arjumand Rizvi
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Sajid Muhammad
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Amjad Hussain
- Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Imran Ahmed
- Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Masawar Hussain
- Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Muhammad Usman
- Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Junaid Iqbal
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Zahid Memon
- Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Sajid Bashir Soofi
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
- Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Zulfiqar A. Bhutta
- Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
- Institute of Global Health and Development, Aga Khan University, Karachi, Pakistan
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Wu XN, Xue F, Zhang N, Zhang W, Hou JJ, Lv Y, Xiang JX, Zhang XF. Global burden of liver cirrhosis and other chronic liver diseases caused by specific etiologies from 1990 to 2019. BMC Public Health 2024; 24:363. [PMID: 38310221 PMCID: PMC10837876 DOI: 10.1186/s12889-024-17948-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 02/01/2024] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND This study aimed to assess the global, regional, and national burden of liver cirrhosis and other chronic liver diseases between 1990 and 2019, considering five etiologies (hepatitis B, hepatitis C, alcohol use, NAFLD and other causes), age, gender, and sociodemographic index (SDI). METHODS Data on liver cirrhosis and other chronic liver diseases mortality, incidence, and disability-adjusted life years (DALYs) were collected from the Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study 2019. RESULTS In 2019, liver cirrhosis and other chronic liver diseases accounted for 1,472,011 (95% UI 1,374,608-1,578,731) deaths worldwide, compared to 1,012,975 (948,941-1,073,877) deaths in 1990. Despite an increase in absolute deaths, the age-standardized death rate declined from 24.43 (22.93-25.73) per 100,000 population in 1990 to 18.00 (19.31-16.80) per 100,000 population in 2019. Eastern sub-Saharan Africa exhibited the highest age-standardized death rate (44.15 [38.47-51.91] per 100,000 population), while Australasia had the lowest rate (5.48 [5.05-5.93] deaths per 100,000 population in 2019). The age-standardized incidence rate of liver cirrhosis and other chronic liver diseases attributed to hepatitis B virus has declined since 1990, but incidence rates for other etiologies have increased. Age-standardized death and DALYs rates progressively decreased with higher SDI across different GBD regions and countries. Mortality due to liver cirrhosis and other chronic liver diseases increased with age in 2019, and the death rate among males was estimated 1.51 times higher than that among females globally. CONCLUSION Liver cirrhosis and other chronic liver diseases continues to pose a significant global public health challenge. Effective disease control, prevention, and treatment strategies should account for variations in risk factors, age, gender, and regional disparities.
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Affiliation(s)
- Xiao-Ning Wu
- Department of Hepatobiliary Surgery, Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, 710061, Xi'an, Shaanxi Province, China
- National-Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Feng Xue
- Department of Hepatobiliary Surgery, Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, 710061, Xi'an, Shaanxi Province, China
| | - Nan Zhang
- Department of Hepatobiliary Surgery, Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, 710061, Xi'an, Shaanxi Province, China
- National-Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Wei Zhang
- Department of Hepatobiliary Surgery, Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, 710061, Xi'an, Shaanxi Province, China
- National-Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Jing-Jing Hou
- Department of Hepatobiliary Surgery, Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, 710061, Xi'an, Shaanxi Province, China
- National-Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Yi Lv
- Department of Hepatobiliary Surgery, Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, 710061, Xi'an, Shaanxi Province, China
- National-Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Jun-Xi Xiang
- Department of Hepatobiliary Surgery, Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, 710061, Xi'an, Shaanxi Province, China.
- National-Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.
| | - Xu-Feng Zhang
- Department of Hepatobiliary Surgery, Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, 710061, Xi'an, Shaanxi Province, China.
- National-Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.
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Veerus P, Nõmm O, Innos K, Allvee K, Karro H. SARS-CoV-2 infection during pregnancy and perinatal outcomes in Estonia in 2020 and 2021: A register-based study. Acta Obstet Gynecol Scand 2024; 103:250-256. [PMID: 37974467 PMCID: PMC10823385 DOI: 10.1111/aogs.14721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/22/2023] [Accepted: 10/29/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION Data from different countries show partly controversial impact of SARS-CoV-2 infection on pregnancy outcomes. A nationwide register-based study was conducted in Estonia to assess the impact of SARS-CoV-2 infection at any time during pregnancy on stillbirth, perinatal mortality, Apgar score at 5 minutes, cesarean section rates, rates of preterm birth and preeclampsia. MATERIAL AND METHODS Data on all newborns and their mothers were obtained from the Estonian Medical Birth Registry, and data on SARS-CoV-2 testing dates, test results and vaccination dates against SARS-CoV-2 from the Estonian Health Information System. Altogether, 26 211 births in 2020 and 2021 in Estonia were included. All analyses were performed per newborn. Odds ratios with 95% confidence intervals (CI) were analyzed for all outcomes, adjusted for mother's place of residence, body mass index, age of mother at delivery and hypertension and for all the aforementioned variables together with mother's vaccination status using data from 2021 when vaccinations against SARS-CoV-2 became available. For studying the effect of a positive SARS-CoV-2 test during pregnancy on preeclampsia, hypertension was omitted from the models to avoid overadjustment. RESULTS SARS-CoV-2 infection during pregnancy was associated with an increased risk of stillbirth (adjusted odds ratio [aOR] 2.81; 95% CI 1.37-5.74) and perinatal mortality (aOR 2.34; 95% CI 1.20-4.56) but not with a lower Apgar score at 5 minutes, higher risk of cesarean section, preeclampsia or preterm birth. Vaccination slightly decreased the impact of SARS-CoV-2 infection during pregnancy on perinatal mortality. CONCLUSIONS A positive SARS-CoV-2 test during pregnancy was associated with higher rates of stillbirth and perinatal mortality in Estonia but was not associated with change in preeclampsia, cesarean section or preterm birth rates.
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Affiliation(s)
- Piret Veerus
- Department of Epidemiology and BiostatisticsNational Institute for Health DevelopmentTallinnEstonia
- West–Tallinn Central Hospital Women's ClinicTallinnEstonia
| | - Oskar Nõmm
- Department of Epidemiology and BiostatisticsNational Institute for Health DevelopmentTallinnEstonia
| | - Kaire Innos
- Department of Epidemiology and BiostatisticsNational Institute for Health DevelopmentTallinnEstonia
| | - Kärt Allvee
- Estonian Medical Birth RegistryNational Institute for Health DevelopmentTallinnEstonia
| | - Helle Karro
- University of TartuTartuEstonia
- Tartu University HospitalTartuEstonia
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Wallace J, Hoehn‐Velasco L, Tilden E, Dowd BE, Calvin S, Jolles DR, Wright J, Stapleton S. An alternative model of maternity care for low-risk birth: Maternal and neonatal outcomes utilizing the midwifery-based birth center model. Health Serv Res 2024; 59:e14222. [PMID: 37691323 PMCID: PMC10771911 DOI: 10.1111/1475-6773.14222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023] Open
Abstract
OBJECTIVE To assess key birth outcomes in an alternative maternity care model, midwifery-based birth center care. DATA SOURCES The American Association of Birth Centers Perinatal Data Registry and birth certificate files, using national data collected from 2009 to 2019. STUDY DESIGN This observational cohort study compared key clinical birth outcomes of women at low risk for perinatal complications, comparing those who received care in the midwifery-based birth center model versus hospital-based usual care. Linear regression analysis was used to assess key clinical outcomes in the midwifery-based group as compared with hospital-based usual care. The hospital-based group was selected using nearest neighbor matching, and the primary linear regressions were weighted using propensity score weights (PSWs). The key clinical outcomes considered were cesarean delivery, low birth weight, neonatal intensive care unit admission, breastfeeding, and neonatal death. We performed sensitivity analyses using inverse probability weights and entropy balancing weights. We also assessed the remaining role of omitted variable bias using a bounding methodology. DATA COLLECTION Women aged 16-45 with low-risk pregnancies, defined as a singleton fetus and no record of hypertension or cesarean section, were included. The sample was selected for records that overlapped in each year and state. Counties were included if there were at least 50 midwifery-based birth center births and 300 total births. After matching, the sample size of the birth center cohort was 85,842 and the hospital-based cohort was 261,439. PRINCIPAL FINDINGS Women receiving midwifery-based birth center care experienced lower rates of cesarean section (-12.2 percentage points, p < 0.001), low birth weight (-3.2 percentage points, p < 0.001), NICU admission (-5.5 percentage points, p < 0.001), neonatal death (-0.1 percentage points, p < 0.001), and higher rates of breastfeeding (9.3 percentage points, p < 0.001). CONCLUSIONS This analysis supports midwifery-based birth center care as a high-quality model that delivers optimal outcomes for low-risk maternal/newborn dyads.
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Affiliation(s)
- Jacqueline Wallace
- American Association of Birth Centers Research CommitteePerkiomenvillePennsylvaniaUSA
| | - Lauren Hoehn‐Velasco
- Department of Economics, Andrew Young School of Policy StudiesGeorgia State UniversityAtlantaGeorgiaUSA
| | - Ellen Tilden
- Nurse‐Midwifery Department, School of NursingOregon Health and Science UniversityPortlandOregonUSA
- Department of OBGYN, School of MedicineOregon Health and Science UniversityPortlandOregonUSA
| | - Bryan E. Dowd
- Division of Health Policy and Management, School of Public HealthUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Steve Calvin
- Department of Obstetrics, Gynecology and Women's HealthUniversity of Minnesota Medical SchoolMinneapolisMinnesotaUSA
| | | | - Jennifer Wright
- American Association of Birth Centers Research CommitteePerkiomenvillePennsylvaniaUSA
| | - Susan Stapleton
- American Association of Birth Centers Research CommitteePerkiomenvillePennsylvaniaUSA
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Oyelese Y, Javinani A, Shamshirsaz AA. Perinatal Mortality Despite Prenatal Diagnosis of Vasa Previa: A Systematic Review. Obstet Gynecol 2024; 143:e22. [PMID: 38237163 DOI: 10.1097/aog.0000000000005486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Affiliation(s)
- Yinka Oyelese
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Maternal Fetal Care Center, Boston Children's Hospital, and Harvard Medical School, Boston, Massachusetts
| | | | - Alireza A Shamshirsaz
- Maternal Fetal Care Center, Boston Children's Hospital, and Harvard Medical School, Boston, Massachusetts
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Yenuberi H, Mathews J, George A, Benjamin S, Rathore S, Tirkey R, Tharyan P. The efficacy and safety of 25 μg or 50 μg oral misoprostol versus 25 μg vaginal misoprostol given at 4- or 6-hourly intervals for induction of labour in women at or beyond term with live singleton pregnancies: A systematic review and meta-analysis. Int J Gynaecol Obstet 2024; 164:482-498. [PMID: 37401143 DOI: 10.1002/ijgo.14970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 06/08/2023] [Accepted: 06/13/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Misoprostol is widely used for cervical ripening and labour induction as it is heat-stable and inexpensive. Oral misoprostol 25 μg given 2-hourly is recommended over vaginal misoprostol 25 μg given 6-hourly, but the need for 2-hourly fetal monitoring makes oral misoprostol impractical for routine use in high-volume obstetric units in resource-constrained settings. OBJECTIVES To compare the efficacy and safety of oral misoprostol initiated at 25 or 50 μg versus 25 μg vaginal misoprostol given at 4- to 6-hourly intervals for labor induction in women at or beyond term (≥ 37 weeks) with a single viable fetus and an unscarred uterus. SEARCH STRATEGY We identified eligible randomized, parallel-group, labor-induction trials from recent systematic reviews. We additionally searched PubMed, Cochrane CENTRAL, Epistemonikos, and clinical trials registries from February 1, 2020 to December 31, 2022 without language restrictions. Database-specific keywords for cervical priming, labor induction, and misoprostol were used. SELECTION CRITERIA We excluded labor-induction trials exclusively in women with ruptured membranes, in the third trimester, and those that initiated misoprostol at doses not specified in the review's objectives. The primary outcomes were vaginal birth within 24 h, cesarean section, perinatal mortality, neonatal morbidity, and maternal morbidity. The secondary outcomes were uterine hyperstimulation with fetal heart rate changes, and oxytocin augmentation. DATA COLLECTION AND ANALYSIS Two or more authors selected studies independently, assessed risk of bias, and extracted data. We derived pooled weighted risk ratios with 95% confidence intervals (CIs) for each outcome, subgrouping trials by the dose and frequency of misoprostol regimens. We used the I2 statistic to quantify heterogeneity and the random-effects model for meta-analysis when appropriate. We used the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach to assess certainty (confidence) in the effect estimates. MAIN RESULTS Thirteen trials, from Canada, India, Iran, and the US, randomizing 2941 women at ≥37 weeks of gestation with an unfavorable cervix (Bishop score <6), met the eligibility criteria. Five misoprostol regimens were compared: 25 μg oral versus 25 μg vaginal, 4-hourly (three trials); 50 μg oral versus 25 μg vaginal, 4-hourly (five trials); 50 μg followed by 100 μg oral versus 25 μg vaginal, 4-hourly (two trials); 50 μg oral, 4-hourly versus 25 μg vaginal, 6-hourly (one trial); and 50 μg oral versus 25 μg vaginal, 6-hourly (two trials). The overall certainty in the evidence ranged from moderate to very low, due to high risk of bias in 11/13 trials (affecting all outcomes), unexplained heterogeneity (1/7 outcomes), indirectness (1/7 outcomes), and imprecision (4/7 outcomes). Vaginal misoprostol probably increased vaginal deliveries within 24 h compared with oral misoprostol (risk ratio [RR] 0.82, 95% CI 0.70-0.96; 11 trials, 2721 mothers; moderate-certainty evidence); this was more likely with 4-hourly than with 6-hourly vaginal regimens. The risk of cesarean sections did not appreciably differ (RR 1.00, 95% CI 0.80-1.26; 13 trials, 2941 mothers; very low-certainty evidence), although oral misoprostol 25 μg 4-hourly probably increased this risk compared with 25 μg vaginal misoprostol 4-hourly (RR 1.69, 95% CI 1.21-2.36; three trials, 515 mothers). The risk of perinatal mortality (RR 0.67, 95% CI 0.11-3.90; one trial, 196 participants; very low-certainty evidence), neonatal morbidity (RR 0.84, 95% CI 0.67-1.06; 13 trials, 2941 mothers; low-certainty evidence), and maternal morbidity (RR 0.83, 95% CI 0.48-1.44; 6 trials; 1945 mothers; moderate-certainty evidence) did not differ appreciably. The risk of uterine hyperstimulation with fetal heart rate changes may be lower with oral misoprostol (RR 0.70, 95% CI 0.52-0.95; 10 trials, 2565 mothers; low-certainty evidence). Oxytocin augmentation was probably more frequent with oral compared with vaginal misoprostol (RR 1.29, 95% CI 1.10-1.51; 13 trials, 2941 mothers; moderate-certainty evidence). CONCLUSIONS Low-dose, 4- to 6-hourly vaginal misoprostol regimens probably result in more vaginal births within 24 h and less frequent oxytocin use compared with low-dose, 4- to 6-hourly, oral misoprostol regimens. Vaginal misoprostol may increase the risk of uterine hyperstimulation with fetal heart changes compared with oral misoprostol, without increasing the risk of perinatal mortality, neonatal morbidity, or maternal morbidity. Indirect evidence indicates that 25 μg vaginal misoprostol 4-hourly may be more effective and as safe as the recommended 6-hourly vaginal regimen. This evidence could inform clinical decisions in high-volume obstetric units in resource-constrained settings.
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Affiliation(s)
- Hilda Yenuberi
- Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, India
| | - Jiji Mathews
- Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, India
| | - Anne George
- Department of Community Health, Christian Medical College, Vellore, India
| | - Santosh Benjamin
- Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, India
| | - Swati Rathore
- Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, India
| | - Richa Tirkey
- Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, India
| | - Prathap Tharyan
- Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, India
- Clinical Epidemiology Unit, Christian Medical College, Vellore, India
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Oyugi B, Nizalova O, Kendall S, Peckham S. Does a free maternity policy in Kenya work? Impact and cost-benefit consideration based on demographic health survey data. Eur J Health Econ 2024; 25:77-89. [PMID: 36781615 PMCID: PMC10799835 DOI: 10.1007/s10198-023-01575-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 02/03/2023] [Indexed: 06/18/2023]
Abstract
This paper evaluates the overall effect of the Kenyan free maternity policy (FMP) on the main outcomes (early neonatal and neonatal deaths) and intermediate outcomes (delivery through Caesarean Section (CS), skilled birth attendance (SBA), birth in a public hospital and low birth weight (LBW)) using the 2014 Demographic Health Survey. We applied the difference-in-difference (DID) approach to compare births (to the same mothers) happening before and after the start of the policy (June 2013) and a limited cost-benefit analysis (CBA) to assess the net social benefit of the FMP. The probabilities of birth resulting in early neonatal and neonatal mortality are significantly reduced by 17-21% and 19-20%, respectively, after the FMP introduction. The probability of birth happening through CS reduced by 1.7% after implementing the FMP, while that of LBW birth is increased by 3.7% though not statistically significant. SBA and birth in a public facility did not moderate the policy's effects on early neonatal mortality, neonatal mortality, and delivery through CS. They were not significant determinants of the policy effects on the outcomes. There is a significant causal impact of the FMP in reducing the probability of early neonatal and neonatal mortality, but not the delivery through CS. The FMP cost-to-benefit ratio was 21.22, and there were on average 4015 fewer neonatal deaths in 2013/2014 due to the FMP. The net benefits are higher than the costs; thus, there is a need to expand and sustainably fund the FMP to avert more neonatal deaths potentially.
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Affiliation(s)
- Boniface Oyugi
- Centre for Health Services Studies (CHSS), University of Kent, George Allen Wing, Canterbury, CT2 7NF, England.
- University of Nairobi, College of Health Sciences, P.O BOX 19676-00202, Nairobi, Kenya.
| | - Olena Nizalova
- Centre for Health Services Studies (CHSS), University of Kent, George Allen Wing, Canterbury, CT2 7NF, England
- Personal Social Services Research Unit (PSSRU), University of Kent, Cornwallis Central, Canterbury, CT2 7NF, England
- School of Economics, University of Kent, Kennedy Building, Canterbury, CT2 7FS, England
| | - Sally Kendall
- Centre for Health Services Studies (CHSS), University of Kent, George Allen Wing, Canterbury, CT2 7NF, England
| | - Stephen Peckham
- Centre for Health Services Studies (CHSS), University of Kent, George Allen Wing, Canterbury, CT2 7NF, England
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Medeiros PDB, Flenady V, Andrews C, Forbes M, Boyle F, Loughnan SA, Meredith N, Gordon A. Evaluation of an online education program for healthcare professionals on best practice management of perinatal deaths: IMPROVE eLearning. Aust N Z J Obstet Gynaecol 2024; 64:63-71. [PMID: 37551966 DOI: 10.1111/ajo.13743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 07/23/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND The IMPROVE (IMproving Perinatal Mortality Review and Outcomes Via Education) eLearning, developed by the Stillbirth Centre of Research Excellence in partnership with the Perinatal Society of Australia and New Zealand was launched in December 2019. Based on the successful face-to-face program, the eLearning aims to increase availability and accessibility of high-quality online education to healthcare professionals providing care for families around the time of perinatal death, to improve the delivery of respectful and supportive clinical care and increase best practice investigation of perinatal deaths. AIMS To evaluate participants' reported learning outcomes (change in knowledge and confidence) and overall acceptability of the program. METHODS Pre- and post-eLearning in-built surveys were collected over two years (Dec. 2019-Nov. 2021), with a mix of Likert and polar questions. Pre- and post-eLearning differences in knowledge and confidence were assessed using McNemar's test. Subgroup analysis of overall acceptability by profession was assessed using Pearson's χ2 . RESULTS One thousand, three hundred and thirty-nine participants were included. The majority were midwives (80.2%, n = 1074). A significant improvement in knowledge and confidence was shown across all chapters (P < 0.01). The chapter showing the greatest improvement was perinatal mortality audit and classification (21.5% pre- and 89.2% post-education). Over 90% of respondents agreed the online education was relevant, helpful, acceptable, engaging. Importantly, 80.7% of participants considered they were likely to change some aspect of their clinical practice after the eLearning. There was no difference in responses to relevance and acceptability of the eLearning program by profession. CONCLUSIONS The IMPROVE eLearning is an acceptable and engaging method of delivery for clinical education, with the potential to improve care and management of perinatal deaths.
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Affiliation(s)
- Poliana de Barros Medeiros
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
- Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
| | - Vicki Flenady
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Christine Andrews
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Madeline Forbes
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Fran Boyle
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
- Institute for Social Science Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Siobhan A Loughnan
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Natasha Meredith
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Adrienne Gordon
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
- The University of Sydney, Sydney, New South Wales, Australia
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