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Pitfalls of International Classification of Diseases - Perinatal mortality in analysing stillbirths.Public Health Dec 2021This study aimed to evaluate the trend of stillbirth from 2009 to 2018. The causes of stillbirth were classified using the International Classification of Diseases -...
OBJECTIVES
This study aimed to evaluate the trend of stillbirth from 2009 to 2018. The causes of stillbirth were classified using the International Classification of Diseases - Perinatal Mortality (ICD-PM).
STUDY DESIGN AND METHODS
A retrospective chart review was performed on 135 stillbirths from 2009 to 2018 in a tertiary university teaching hospital. The annual stillbirth rate was calculated, and the trend was evaluated. The cause of death was reclassified using ICD-PM.
RESULTS
The stillbirth rate was 3.70 per 1000 total births, and it remained stable over the studied period (P = 0.238). Most of the stillbirth (97.8%) were antepartum deaths. The proportion of unexplained stillbirth was reduced from 57% to 18.5% after reclassified by ICD-PM coding. Another major cause of antepartum stillbirths was disorders related to fetal growth, which consisted of mothers with medical and surgical conditions (11%, n = 15, ICD-PM code A5, M4) or mothers with complications of placenta, cord and membranes (8.9%, n = 12, ICD-PM code A5, M1).
CONCLUSION
The use of ICD-PM was useful in reducing the proportion of unexplained stillbirths. ICD-PM has the advantages of coding related to the timing of stillbirth and associated maternal conditions. Pitfalls including the unclear use of the code A3-'antepartum hypoxia,' guidance on coding of well-controlled maternal medical conditions and placental pathology and the importance of subcategorisation need to be addressed.
Topics: Female; Humans; Pregnancy; Cause of Death; International Classification of Diseases; Perinatal Mortality; Placenta; Retrospective Studies; Stillbirth; Infant, Newborn
PubMed: 34742112
DOI: 10.1016/j.puhe.2021.09.032 -
American Journal of Perinatology Jan 2020To determine if women with an antepartum admission for hypertensive diseases of pregnancy (HDP) were at increased risk for stillbirth.
OBJECTIVE
To determine if women with an antepartum admission for hypertensive diseases of pregnancy (HDP) were at increased risk for stillbirth.
STUDY DESIGN
This study utilized the 2010 to 2014 Nationwide Readmissions Database. Antepartum admissions with HDP were identified and linked to subsequent delivery hospitalizations. Delivery hospitalizations with HDP without a preceding antepartum HDP admission were also identified. Risk for stillbirth, abruption, or both was compared between these two groups.
RESULTS
An estimated 382,621 deliveries with an HDP diagnosis were identified of which 14,857 (3.9%) had a preceding antepartum admission for HDP. Stillbirth occurred in 7.8 per 1,000 delivery hospitalizations complicated by HDP with risk higher with a preceding HDP antepartum admission in both unadjusted (1.1 vs. 0.8%, risk ratios [RR] 1.46, 95% confidence interval [CI] 1.24-1.70) and adjusted (adjusted risk ratios [aRR] 1.24, 95% CI 1.06, 1.46) analyses. Abruption occurred in 19.6 per 1,000 delivery hospitalizations complicated by HDP with risk higher with a preceding HDP antepartum admission in both unadjusted (2.5 vs. 1.9%, RR 1.30, 95% CI 1.17-1.44) and adjusted (aRR 1.24, 95% CI 1.11, 1.37) analyses. Risk for combined abruption and stillbirth did not differ significantly.
CONCLUSION
In this analysis, prior antenatal hospitalization was associated with increased risk for stillbirth among women with HDP.
Topics: Abruptio Placentae; Adolescent; Adult; Female; Hospitalization; Humans; Hypertension, Pregnancy-Induced; Middle Aged; Odds Ratio; Patient Readmission; Pregnancy; Prenatal Care; Risk; Stillbirth; Young Adult
PubMed: 31563137
DOI: 10.1055/s-0039-1697589 -
Journal of Obstetrics and Gynaecology... Jun 2022Stillbirth is a global health problem having many emotional, social and economic consequences. India has the largest number of stillbirths per year in the world.
INTRODUCTION
Stillbirth is a global health problem having many emotional, social and economic consequences. India has the largest number of stillbirths per year in the world.
OBJECTIVE
The objective of this study is to review the causes of stillbirth and classify the causes into maternal, foetal and placental causes and further classify causes by relevant condition at death (ReCoDe) classification. We intend to observe the causes of and demographic factors contributing to the burden of stillbirths. Using this data, the areas of action can be identified and measures can be formulated to reduce a significant number of perinatal mortalities.
METHODOLOGY
This is an observational study of data collected over one year (January 2019-December 2019) from a tertiary care centre in Mumbai, India. The maternal demographic characteristics and causes of stillbirth were studied. The causes of stillbirths were classified into maternal, foetal and placental causes and relevant condition at death (ReCoDe) classification [1].
RESULTS
A total of 9074 babies were delivered during this period. There were 275 stillbirths in this year (SBR 30.3 per 1000 total births). Majority of the mothers were in the age group of 26-30 years (32.7%). Almost all the mothers (98.5%) were from urban areas. As per the modified Kuppuswamy classification for urban India, 195 (71.79%) belonged to the upper lower class. 31.2% were primigravidae, and 54.8% had 3 or more antenatal visits. Maternal conditions (pre-eclampsia, diabetes, pre-existing medical disorders) as a group were the cause of maximum number (42%) of stillbirths either directly or as a contributory risk factor. 78% of the stillbirths occurred in the antepartum period. Ours being a referral centre, 65% subjects in the study were referred to us from other peripheral hospitals. 53.8% of the stillborn babies were male. 58.9% were macerated stillbirths. According to the ReCoDe classification, hypertensive disease in pregnancy was the most common cause of stillbirths (76) followed by foetal growth restriction (30).
CONCLUSION
Most of the stillbirths in this study were due to maternal medical conditions. Out of these conditions, hypertensive disorders of pregnancy and its consequences were the most common (66.08%). Better regulation of the private healthcare sector, provision of healthcare providers and better equipments in peripheral health centres and a well-chalked out referral system will contribute to reduction in the number of preventable stillbirths. Regular facility-based stillbirth review meetings and healthcare provider accountability would also help to reduce the burden of this silent epidemic as well as reach the goal of a "single-digit" stillbirth rate by the year 2030.
PubMed: 35734358
DOI: 10.1007/s13224-021-01571-1 -
Journal of Clinical Medicine Dec 2021(1) Background: Across Europe, the incidence of antepartum stillbirth varies greatly, partly because of heterogeneous definitions regarding gestational weeks and...
(1) Background: Across Europe, the incidence of antepartum stillbirth varies greatly, partly because of heterogeneous definitions regarding gestational weeks and differences in legislation. With this study, we sought to provide a comprehensive overview on the demographics of antepartum stillbirth in Austria, defined as non-iatrogenic fetal demise ≥22 gestational weeks (/40). (2) Methods: We conducted a population-based study on epidemiological characteristics of singleton antepartum stillbirth in Austria between January 2008 and December 2020. Data were derived from the validated Austrian Birth Registry. (3) Results: From January 2008 through December 2020, the antepartum stillbirth rate ≥20/40 was 3.10, ≥22/40 3.14, and ≥24/40 2.83 per 1000 births in Austria. The highest incidence was recorded in the federal states of Vienna, Styria, and Lower and Upper Austria, contributing to 71.9% of all stillbirths in the country. In the last decade, significant fluctuations in incidence were noted: from 2011 to 2012, the rate significantly declined from 3.40 to 3.07‰, whilst it significantly increased from 2.76 to 3.49‰ between 2019 and 2020. The median gestational age of antepartum stillbirth in Austria was 33 (27-37) weeks. Stillbirth rates ≤26/40 ranged from 164.98 to 334.18‰, whilst the lowest rates of 0.58-8.4‰ were observed ≥36/40. The main demographic risk factors were maternal obesity and low parity. (4) Conclusions: In Austria, the antepartum stillbirth rate has remained relatively stable at 2.83-3.10 per 1000 births for the last decade, despite a significant decline in 2012 and an increase in 2020.
PubMed: 34945123
DOI: 10.3390/jcm10245828 -
BMJ Open Aug 2023In high mortality settings, prophylactic azithromycin has been shown to improve birth weight and gestational age at birth when administered antenatally, to reduce the...
INTRODUCTION
In high mortality settings, prophylactic azithromycin has been shown to improve birth weight and gestational age at birth when administered antenatally, to reduce the incidence of neonatal infections when administered intrapartum, and to improve survival when administered in infancy. Questions remain regarding whether azithromycin can prevent stillbirths, and regarding the optimal strategy for the delivery of azithromycin to pregnant women and their infants.
METHODS AND ANALYSIS
Sauver avec l'Azithromycine en Traitant les Femmes Enceintes et les Enfants (SANTE) is a 2×2 factorial, individually randomised, placebo-controlled, double-masked trial in rural Mali. The primary aims are: (1A) to assess the efficacy of antenatal and intrapartum azithromycin on a composite outcome of stillbirths and infant mortality through 6-12 months and (1B) to assess the efficacy of azithromycin administered concurrently with the first and third doses of pentavalent vaccines (Penta-1/3) on infant mortality through 6-12 months. Pregnant participants (n=49 600) and their infants are randomised 1:1:1:1 to one of four treatment arms: (1) mother and infant receive azithromycin, (2) mother and infant receive placebo, (3) mother receives azithromycin and infant receives placebo or (4) mother receives placebo and infant receives azithromycin. Pregnant participants receive three single 2 g doses: two antepartum and one intrapartum. Infants receive a single 20 mg/kg dose at the Penta-1 and 3 visits. An additional cohort of 12 000 infants is recruited at the Penta-1 visit and randomised 1:1 to receive azithromycin or placebo at the same time points. The SANTE trial will inform guidelines and policies regarding the administration of antenatal and infant azithromycin using routine healthcare delivery platforms.
ETHICS AND DISSEMINATION
This trial was approved by the Institutional Review Board at the University of Maryland School of Medicine (Protocol #HP-00084242) and the Faculté de Médecine et d'Odonto-Stomatologie in Mali. The findings of this trial will be published in open access peer-reviewed journals.
TRIAL REGISTRATION NUMBER
NCT03909737.
Topics: Pregnancy; Infant, Newborn; Female; Infant; Humans; Stillbirth; Azithromycin; Mali; Parturition; Infant Death; Randomized Controlled Trials as Topic
PubMed: 37648393
DOI: 10.1136/bmjopen-2022-067581 -
International Journal of Gynaecology... Mar 2022The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 has had dramatic effects on the pregnant population worldwide,...
BACKGROUND
The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 has had dramatic effects on the pregnant population worldwide, increasing the risk of adverse perinatal outcomes.
OBJECTIVE
To assess the incidence of antepartum stillbirth (aSB) during the COVID-19 pandemic in Austria.
METHODS
We collected epidemiological data from the Austrian Birth Registry and compared the rate of aSB (i.e., fetal death at or after 24 gestational weeks) during the pandemic period (March-December 2020) and in the respective pre-pandemic months (2015-2019).
RESULTS
In total, 65 660 pregnancies were included, of which 171 resulted in aSB at 33.7 ± 4.8 gestational weeks. During the pandemic, the aSB rate increased from 2.49‰ to 2.60‰ (P = 0.601), in contrast to the significant decline in preterm deliveries at or before 37 gestational weeks from 0.61‰ to 0.56‰ (relative risk [RR] 0.93; 95% confidence interval [CI] 0.91-0.96; P < 0.001). During the first lockdown, the aSB rate significantly increased from 2.38‰ to 3.52‰ (P = 0.021), yielding an adjusted odds ratio of 1.57 (95% CI 1.08-2.27; P = 0.018). The event of aSB during the COVID-19 pandemic was strongly related with increased fetal weight and maternal obesity.
CONCLUSION
In Austria, there has been an overall increase in the incidence of aSB during the pandemic with a significant peak during the first lockdown.
Topics: Austria; COVID-19; Communicable Disease Control; Female; Humans; Infant, Newborn; Pandemics; Pregnancy; Pregnancy Outcome; Premature Birth; SARS-CoV-2; Stillbirth
PubMed: 34669186
DOI: 10.1002/ijgo.13989 -
Obstetrics and Gynecology Jun 2021The goal of antepartum fetal surveillance is to reduce the risk of stillbirth. Antepartum fetal surveillance techniques based on assessment of fetal heart rate (FHR)...
The goal of antepartum fetal surveillance is to reduce the risk of stillbirth. Antepartum fetal surveillance techniques based on assessment of fetal heart rate (FHR) patterns have been in clinical use for almost four decades and are used along with real-time ultrasonography and umbilical artery Doppler velocimetry to evaluate fetal well-being. Antepartum fetal surveillance techniques are routinely used to assess the risk of fetal death in pregnancies complicated by preexisting maternal conditions (eg, diabetes mellitus) as well as those in which complications have developed (eg, fetal growth restriction). The purpose of this document is to provide a review of the current indications for and techniques of antepartum fetal surveillance and outline management guidelines for antepartum fetal surveillance that are consistent with the best scientific evidence.
PubMed: 34011881
DOI: 10.1097/AOG.0000000000004411 -
PloS One 2023Stillbirths are indicators of the quality of obstetrics care in health systems. Stillbirth rates and their associating factors vary by socio-economic and geographical...
BACKGROUND
Stillbirths are indicators of the quality of obstetrics care in health systems. Stillbirth rates and their associating factors vary by socio-economic and geographical settings. Published data on stillbirths and their associating factors in the Volta Region of Ghana are limited. This limits understanding of local factors that must be considered in designing appropriate interventions to mitigate the occurrence of stillbirths. This study determined the incidence of stillbirths and associated factors among deliveries at Ho Teaching Hospital (HTH) and contributes to understanding the consistent high stillbirths in the country and potentially in other low-resourced settings in sub-Saharan Africa.
METHOD
This was a prospective cohort study involving pregnant women admitted for delivery at HTH between October 2019 and March 2020. Data on socio-demographic characteristics such as age and employment, obstetric factors including gestational age at delivery and delivery outcomes like birthweight were collected using a pretested structured questionnaire. The primary outcome was the incidence of stillbirths at the facility. Summary statistics were reported as frequencies, percentages and means. Logistic regression methods were used to assess for association between stillbirths and independent variables including age and birthweight. Odds ratios were reported with 95% confidence intervals and associations with p-values < 0.05 were considered statistically significant.
RESULTS
A total of 687 women and their 702 newborns contributed data for analysis. The mean age (SD) was 29.3 (6.3) years and close to two-thirds had had at least one delivery previously. Overall stillbirth incidence was 31.3 per 1000 births. Of the 22 stillbirths, 17 were antepartum. Pre-eclampsia was the most common hypertensive disorder of pregnancy observed (49.3%, 33/67). Among others, less than 3 antenatal visits and low birthweight increased the odds of stillbirths in the bivariate analysis. In the final multivariate model, pregnancy and delivery at 28-34 weeks gestation [AOR 9.37(95% CI 1.18-74.53); p = 0.034] and induction of labour [AOR 11.06 (95% CI 3.10-39.42); p < 0.001] remained significantly associated with stillbirths.
CONCLUSION
Stillbirth incidence was 31.3 per 1000 births with more than half being antepartum stillbirths. Pregnancy/delivery at 28-34 weeks' gestation increased the odds of a stillbirth. Improving the quality of antenatal services, ensuring adherence to evidence-based protocols, accurate and prompt diagnosis and timely interventions of medical conditions in pregnancy particularly at 28-34 weeks' gestation could reduce incidence of stillbirths.
Topics: Pregnancy; Female; Infant, Newborn; Humans; Adult; Stillbirth; Birth Weight; Ghana; Incidence; Prospective Studies; Health Facilities
PubMed: 38128029
DOI: 10.1371/journal.pone.0296076 -
International Journal of Gynaecology... Aug 2021To evaluate the association between obstetric and medical risk factors and stillbirths in a Kenyan set-up.
OBJECTIVE
To evaluate the association between obstetric and medical risk factors and stillbirths in a Kenyan set-up.
METHODS
A case-control study was conducted in four hospitals between August 2018 and April 2019. Two hundred and fourteen women with stillbirths and 428 with live births at more than >28 weeks of gestation were enrolled. Data collection was via interviews and abstraction from medical records. Outcome variables were stillbirth and live birth; exposure variables were sociodemographic characteristics, and medical and obstetric factors. The two-sample t test and χ test were used to compare continuous and categorical variables respectively. The association between the exposure and outcome variable was done using logistic regression. A P value less than 0.05 was considered statistically significant.
RESULTS
Stillbirth was associated with pre-eclampsia without severe features (odds ratio [OR] 9.1, 95% confidence interval [CI] 2.6-32.5), pre-eclampsia with severe features (OR 7.4, 95% CI 2.4-22.8); eclampsia (OR 9.2, 95% CI 2.6-32.5), placenta previa (OR 8.6 95% CI 2.8-25.9), placental abruption (OR 6.9 95% CI 2.2-21.3), preterm delivery(OR 9.5, 95% CI 5.7-16), and gestational diabetes mellitus, (OR 11.5, 95% CI 2.5-52.6). Stillbirth was not associated with multiparity, anemia, and HIV.
CONCLUSION
Proper antepartum care and surveillance to identify and manage medical and obstetric conditions with the potential to cause stillbirth are recommended.
Topics: Adult; Case-Control Studies; Diabetes, Gestational; Female; Humans; Infant, Newborn; Kenya; Obstetric Labor Complications; Parity; Placenta; Poverty; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Premature Birth; Prenatal Care; Risk Factors; Stillbirth; Young Adult
PubMed: 33306840
DOI: 10.1002/ijgo.13528 -
Journal of Perinatal Medicine Jul 2022This study aimed to assess parents' satisfaction with received care and support when experiencing stillbirth.
OBJECTIVES
This study aimed to assess parents' satisfaction with received care and support when experiencing stillbirth.
METHODS
This was a questionnaire survey conducted at Helsinki University Hospital, Helsinki, Finland during 2016-2020. Separate questionnaires were sent to mothers and partners who had experienced an antepartum singleton stillbirth at or after 22 gestational weeks during 2016-2019. The questionnaire covered five major topics: stillbirth diagnosis, delivery, information on postmortem examinations, aftercare at the ward, and follow-up appointment.
RESULTS
One hundred nineteen letters were sent and 57 (47.9%) of the mothers and 46 (38.7%) of their partners responded. Both mothers and their partners felt well supported during delivery. They were also satisfied with the time holding their newborn. Partners reported even higher satisfaction in this aspect with a significant within-dyad difference (p=0.049). Parents were generally pleased with the support at the ward. However, both groups were less satisfied with social worker counseling (mothers 53.7%, partners 61.0%). The majority felt that the follow-up visit was helpful. Nonetheless, a remarkable proportion felt that the follow-up visit increased their anxiousness (25.9%, 14.0%, p=0.018). Partners rated their mood higher than mothers (p=0.001). Open feedback revealed that the support received after discharge from hospital was often insufficient.
CONCLUSIONS
Our study showed that the parents who experience stillbirth in our institution receive mostly adequate care and support during their hospital stay. However, there is room for further training of healthcare professionals and other professionals contributing in stillbirth aftercare.
Topics: Aftercare; Female; Humans; Infant, Newborn; Mothers; Parents; Pregnancy; Stillbirth; Surveys and Questionnaires
PubMed: 35700452
DOI: 10.1515/jpm-2022-0246