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International Journal of Women's Health 2021Worldwide, 2.6 million stillbirths occur annually and more than three-quarters of them are recorded in South Asia and Sub-Saharan Africa. Thus, the aim of this study was...
BACKGROUND
Worldwide, 2.6 million stillbirths occur annually and more than three-quarters of them are recorded in South Asia and Sub-Saharan Africa. Thus, the aim of this study was to identify risk factors of stillbirth among women who gave birth in Amhara region referral hospitals found in northwest and northcentral, Ethiopia in 2019.
METHODS
A multi-center institution-based unmatched case-control study was conducted among 456 mothers who gave birth in Amhara region referral hospitals from October 1 to December 30, 2019. Consecutive and simple random sampling was used to select the cases and controls, respectively. A semi-structured, interviewer-administered questionnaire and patient chart reviews were used to collect the data. Epidemiological (Epi) data version 4.4.2.1 and Statistical Package for the Social Sciences (SPSS) version 25.0 were used for data entry and analysis, respectively. Binary logistic regression was employed. An adjusted odds ratio with a 95% confidence interval was used to declare statistically significant variables on the basis of -value<0.05 in the multivariable binary logistic regression model.
RESULTS
Alcohol drinking (adjusted odds ratio (AOR)=3.02, 95% confidence interval (CI)=1.24-7.35), antepartum hemorrhage (AOR=5.74, 95% CI=2.67-12.33), premature rupture of membrane (AOR=2.21, 95% CI=1.09-4.44), meconium-stained amniotic fluid (AOR=8.18, 95% CI=4.29-15.60), non-use of partograph for labor follow-up (AOR=3.89, 95% CI=2.12-7.17), induction of labor (AOR=2.12, 95% CI=1.09-4.11), previous history of stillbirth (AOR=2.15, 95% CI=1.08-4.26), and birthweight less than 2,500 grams (AOR=7.36, 95% CI=3.43-15.81) increase the odds of stillbirth.
CONCLUSION
Stillbirth was higher among women who drank alcohol during their pregnancy, experienced antepartum hemorrhage, premature rupture of membrane, meconium-stained amniotic fluid, induction of labor, labor not followed by partograph, previous history of stillbirth, and birthweight less than 2,500 grams. As such, education to stop alcohol drinking during pregnancy, monitoring the progress of labor with partograph, and improving the quality of care for mothers and newborns at the time of pregnancy and childbirth will contribute to preventing stillbirth.
PubMed: 34149288
DOI: 10.2147/IJWH.S305786 -
Scientific Reports Jan 2023The Greater Accra Region (GAR) of Ghana records 2000 stillbirths annually and 40% of them occur intrapartum. An understanding of the contributing factors will facilitate...
Modeling clinical and non-clinical determinants of intrapartum stillbirths in singletons in six public hospitals in the Greater Accra Region of Ghana: a case-control study.
The Greater Accra Region (GAR) of Ghana records 2000 stillbirths annually and 40% of them occur intrapartum. An understanding of the contributing factors will facilitate the development of preventive strategies to reduce the huge numbers of intrapartum stillbirths. This study identified determinants of intrapartum stillbirths in GAR. A retrospective 1:2 unmatched case-control study was conducted in six public hospitals in the Greater Accra Region of Ghana. A multivariable binary logistic regression model was used to quantify the effect of exposures on intrapartum stillbirth. The area under the receiver operating characteristics curve and the Brier scores were used to screen potential risk factors and assess the predictive performance of the regression models. The following maternal factors increased the odds of intrapartum stillbirths: pregnancy-induced hypertension (PIH) [adjusted Odds Ratio; aOR = 3.72, 95% CI:1.71-8.10, p < 0.001]; antepartum haemorrhage (APH) [aOR = 3.28, 95% CI: 1.33-8.10, p < 0.05] and premature rupture of membranes (PROM) [aOR = 3.36, 95% CI: 1.20-9.40, p < 0.05]. Improved management of PIH, APH, PROM, and preterm delivery will reduce intrapartum stillbirth. Hospitals should improve on the quality of monitoring women during labor. Auditing of intrapartum stillbirths should be mandatory for all hospitals and Ghana Health Service should include fetal autopsy in stillbirth auditing to identify other causes of fetal deaths. Interventions to reduce intrapartum stillbirth must combine maternal, fetal and service delivery factors to make them effective.
Topics: Pregnancy; Infant, Newborn; Female; Humans; Stillbirth; Case-Control Studies; Retrospective Studies; Ghana; Obstetric Labor Complications; Hypertension, Pregnancy-Induced; Uterine Hemorrhage; Risk Factors; Hospitals, Public
PubMed: 36653381
DOI: 10.1038/s41598-022-27088-9 -
The Pan African Medical Journal 2022fetal adverse birth outcomes are abnormal outcomes such as prematurity, low birth weight, stillbirth, and birth defects. It is the main cause of neonatal and child...
Proportion and factors associated with fetal adverse birth outcome among mothers who gave birth at Felege Hiwot Comprehensive Specialized Hospital, Bahir Dar city, Northwest, Ethiopia 2019.
INTRODUCTION
fetal adverse birth outcomes are abnormal outcomes such as prematurity, low birth weight, stillbirth, and birth defects. It is the main cause of neonatal and child deaths in the world and is the major public health problem in developing countries including Ethiopia. This study aims to assess the proportion and factors associated with fetal adverse birth outcomes among mothers who gave birth at Felege Hiwot Comprehensive Specialized Hospital, Bahir Dar city, North-west, Ethiopia 2019.
METHODS
institution-based cross-sectional study was conducted from March 1- to April 30 in 2019 among 371 delivered mothers. The data were collected by systematic random sampling technique, entered into a computer using Epi data 3.5, and analyzed using Statistical Package of Social Sciences version 23.0. Bivariate and multivariable logistic regression analyses were done to estimate the crude and adjusted odds ratio with a confidence interval of 95% and a P-value of less than 0.05 considered statistically significant.
RESULTS
in this study, the proportion of fetal adverse birth outcome was 33.2%. Mothers who lived in rural area [AOR=4.37, 95% CI=2.44-7.83], < 4 antenatal care visit [AOR=1.91, 95% CI=1.08-3.40], bad obstetrical history [AOR=2.01, 95% CI=1.03-3.93], complication in the antepartum period [AOR=4.32, 95% CI=2.44-7.65], medical illness [AOR=2.44, 95% CI=1.25-4.79], and maternal hemoglobin level < 11 mg/dl [AOR=4.63, 95% CI=2.40-8.93] were significantly associated with fetal adverse birth outcomes.
CONCLUSION
the proportion of fetal adverse birth outcomes in this research was high. Living in a rural area, the number of antenatal care visits, bad obstetrical history, current pregnancy complications, medical illness, and hemoglobin levels less than or equal to 11 mg/dl were significantly associated with fetal adverse birth outcomes. Getting full service of antenatal care visits and advance in the quality of maternal health services could minimize fetal adverse birth outcomes.
Topics: Cross-Sectional Studies; Ethiopia; Female; Hemoglobins; Hospitals; Humans; Infant, Newborn; Mothers; Pregnancy; Pregnancy Complications; Prenatal Care
PubMed: 36034038
DOI: 10.11604/pamj.2022.42.76.34686 -
BMC Pregnancy and Childbirth Oct 2023Antepartum and intrapartum hemorrhage from vasa previa (VP) is one of the main causes of intrauterine fetal death (IUFD). Here, we present two cases with type I VP in...
Antepartum and intrapartum hemorrhage from vasa previa (VP) is one of the main causes of intrauterine fetal death (IUFD). Here, we present two cases with type I VP in which velamentous cord insertion below the fetal head and overlying the cervix were reported by prenatal ultrasound scanning, and IUFD occoured after 35 weeks with no signs of prenatal bleeding but with engaged fetal head at presentation. We hypothesized that the IUFD may attributed to the compression of the unprotected umbilical vessels by the engaged fetal head. Thus we suggest that VP with a velamentous cord insertion should be considered for earlier termination of the pregnancy to avoid the risk of non-hemorrhagic adverse fetal outcomes.
Topics: Pregnancy; Female; Humans; Vasa Previa; Fetal Death; Umbilical Cord; Stillbirth; Ultrasonography, Prenatal; Hemorrhage
PubMed: 37789298
DOI: 10.1186/s12884-023-06019-0 -
PloS One 2020Globally, the under-10 years of age mortality has not been comprehensively studied. We applied the life-course perspective in the analysis and interpretation of the...
Under 10 mortality patterns, risk factors, and mechanisms in low resource settings of Eastern Uganda: An analysis of event history demographic and verbal social autopsy data.
BACKGROUND
Globally, the under-10 years of age mortality has not been comprehensively studied. We applied the life-course perspective in the analysis and interpretation of the event history demographic and verbal autopsy data to examine when and why children die before their 10th birthday.
METHODS
We analysed a decade (2005-2015) of event histories data on 22385 and 1815 verbal autopsies data collected by Iganga-Mayuge HDSS in eastern Uganda. We used the lifetable for mortality estimates and patterns, and Royston-Parmar survival analysis approach for mortality risk factors' assessment.
RESULTS
The under-10 and 5-9 years of age mortality probabilities were 129 (95% Confidence Interval [CI] = 123-370) per 1000 live births and 11 (95% CI = 7-26) per 1000 children aged 5-9 years, respectively. The top four causes of new-born mortality and stillbirth were antepartum maternal complications (31%), intrapartum-related causes including birth injury, asphyxia and obstructed labour (25%), Low Birth Weight (LBW) and prematurity (20%), and other unidentified perinatal mortality causes (18%). Malaria, protein deficiency including anaemia, diarrhoea or gastrointestinal, and acute respiratory infections were the major causes of mortality among those aged 0-9 years-contributing 88%, 88% and 46% of all causes of mortality for the post-neonatal, child and 5-9 years of age respectively. 33% of all causes of mortality among those aged 5-9 years was a share of Injuries (22%) and gastrointestinal (11%). Regarding the deterministic pattern, nearly 30% of the new-borns and sick children died without access to formal care. Access to the treatment for the top five morbidities was after 4 days of symptoms' recognition. The childhood mortality risk factors were LBW, multiple births, having no partner, adolescence age, rural residence, low education level and belonging to a poor household, but their association was stronger among infants.
CONCLUSIONS
We have identified the vulnerable groups at risk of mortality as LBW children, multiple births, rural dwellers, those whose mother are of low socio-economic position, adolescents and unmarried. The differences in causes of mortalities between children aged 0-5 and 5-9 years were noted. These findings suggest for a strong life-course approach in the design and implementation of child health interventions that target pregnant women and children of all ages.
Topics: Adolescent; Adult; Cause of Death; Child; Child Health; Child Mortality; Child, Preschool; Female; Humans; Infant; Infant Health; Infant Mortality; Infant, Newborn; Male; Maternal Health; Maternal-Child Health Services; Medical History Taking; Socioeconomic Factors; Uganda
PubMed: 32525931
DOI: 10.1371/journal.pone.0234573 -
Scientific Reports Dec 2021This study aimed to analyze the distribution of stillbirths by birth weight, type of death, the trend of Stillbirth Rate (SBR), and avoidable causes of death, according... (Comparative Study)
Comparative Study
This study aimed to analyze the distribution of stillbirths by birth weight, type of death, the trend of Stillbirth Rate (SBR), and avoidable causes of death, according to social vulnerability clusters in São Paulo Municipality, 2007-2017. Social vulnerability clusters were created with the k-means method. The Prais-Winsten generalized linear regression was used in the trend of SBR by < 2500 g, ≥ 2500 g, and total deaths analysis. The Brazilian list of avoidable causes of death was adapted for stillbirths. There was a predominance of antepartum stillbirths (70%). There was an increase in SBR with the growth of social vulnerability from the center to the outskirts of the city. The cluster with the highest vulnerability presented SBR 69% higher than the cluster with the lowest vulnerability. SBR ≥ 2500 g was decreasing in the clusters with the high vulnerability. There was an increase in SBR of avoidable causes of death of the cluster from the lowest to the highest vulnerability. Ill-defined causes of death accounted for 75% of deaths in the highest vulnerability area. Rates of fetal mortality and avoidable causes of death increased with social vulnerability. The trend of reduction of SBR ≥ 2500 g may suggest improvement in prenatal care in areas of higher vulnerability.
Topics: Adult; Birth Weight; Brazil; Cause of Death; Cities; Cluster Analysis; Female; Fetal Death; Fetal Mortality; Geography; Humans; Infant, Newborn; Linear Models; Pregnancy; Prenatal Care; Regression Analysis; Social Vulnerability; Stillbirth; Vulnerable Populations
PubMed: 34930961
DOI: 10.1038/s41598-021-03646-5 -
The Lancet. Global Health Aug 2019Maternal and perinatal mortality are still unacceptably high in many countries despite steep increases in facility birth. The evidence that childbirth in facilities...
Does facility birth reduce maternal and perinatal mortality in Brong Ahafo, Ghana? A secondary analysis using data on 119 244 pregnancies from two cluster-randomised controlled trials.
BACKGROUND
Maternal and perinatal mortality are still unacceptably high in many countries despite steep increases in facility birth. The evidence that childbirth in facilities reduces mortality is weak, mainly because of the scarcity of robust study designs and data. We aimed to assess this link by quantifying the influence of major determinants of facility birth (cluster-level facility birth, wealth, education, and distance to childbirth care) on several mortality outcomes, while also considering quality of care.
METHODS
Our study is a secondary analysis of surveillance data on 119 244 pregnancies from two large population-based cluster-randomised controlled trials in Brong Ahafo, Ghana. In addition, we specifically collected data to assess quality of care at all 64 childbirth facilities in the study area. Outcomes were direct maternal mortality, perinatal mortality, first-day and early neonatal mortality, and antepartum and intrapartum stillbirth. We calculated cluster-level facility birth as the percentage of facility births in a woman's village over the preceding 2 years, and we computed distances from women's regular residence to health facilities in a geospatial database. Associations between determinants of facility birth and mortality outcomes were assessed in crude and multivariable multilevel logistic regression models. We stratified perinatal mortality effects by three policy periods, using April 1, 2005, and July 1, 2008, as cutoff points, when delivery-fee exemption and free health insurance were introduced in Ghana. These policies increased facility birth and potentially reduced quality of care.
FINDINGS
Higher proportions of facility births in a cluster were not linked to reductions in any of the mortality outcomes. In women who were wealthier, facility births were much more common than in those who were poorer, but mortality was not lower among them or their babies. Women with higher education had lower mortality risks than less-educated women, except first-day and early neonatal mortality. A substantially higher proportion of women living in areas closer to childbirth facilities had facility births and caesarean sections than women living further from childbirth facilities, but mortality risks were not lower despite this increased service use. Among women who lived in areas closer to facilities offering comprehensive emergency obstetric care (CEmOC), emergency newborn care, or high-quality routine care, or to facilities that had providers with satisfactory competence, we found a lower risk of intrapartum stillbirth (14·2 per 1000 deliveries at >20 km from a CEmOC facility vs 10·4 per 1000 deliveries at ≤1 km; odds ratio [OR] 1·13, 95% CI 1·06-1·21) and of composite mortality outcomes than among women living in areas where these services were further away. Protective effects of facility birth were restricted to the two earlier policy periods (from June 1, 2003, to June 30, 2008), whereas there was evidence for higher perinatal mortality with increasing wealth (OR 1·09, 1·03-1·14) and lower perinatal mortality with increasing distance from childbirth facilities (OR 0·93, 0·89-0·98) after free health insurance was introduced in July 1, 2008.
INTERPRETATION
Facility birth does not necessarily convey a survival benefit for women or babies and should only be recommended in facilities capable of providing emergency obstetric and newborn care and capable of safe-guarding uncomplicated births.
FUNDING
The Baden-Württemberg Foundation, the Daimler and Benz Foundation, the European Social Fund and Ministry of Science, Research, and the Arts Baden-Württemberg, WHO, US Agency for International Development, Save the Children, the Bill & Melinda Gates Foundation, and the UK Department for International Development.
Topics: Adolescent; Adult; Female; Humans; Middle Aged; Pregnancy; Young Adult; Delivery, Obstetric; Ghana; Health Facilities; Maternal Mortality; Perinatal Mortality; Population Surveillance; Randomized Controlled Trials as Topic; Infant, Newborn
PubMed: 31303295
DOI: 10.1016/S2214-109X(19)30165-2 -
PloS One 2021To assess the feasibility of the application of International Classification of Diseases-10-to perinatal mortality (ICD-PM) in a busy low-income referral hospital and...
OBJECTIVE
To assess the feasibility of the application of International Classification of Diseases-10-to perinatal mortality (ICD-PM) in a busy low-income referral hospital and determine the timing and causes of perinatal deaths, and associated maternal conditions.
DESIGN
Prospective application of ICD-PM.
SETTING
Referral hospital of Mnazi Mmoja Hospital, Zanzibar, United Republic of Tanzania.
POPULATION
Stillbirths and neonatal deaths with a birth weight above 1000 grams born between October 16th 2017 to May 31st 2018.
METHODS
Clinical information and an adapted WHO ICD-PM interactive excel-based system were used to capture and classify the deaths according to timing, causes and associated maternal complications. Descriptive analysis was performed.
MAIN OUTCOME MEASURES
Timing and causes of perinatal mortality and their associated maternal conditions.
RESULTS
There were 661 perinatal deaths of which 248 (37.5%) were neonatal deaths and 413 (62.5%) stillbirths. Of the stillbirths, 128 (31%) occurred antepartum, 129 (31%) intrapartum and for 156 (38%) the timing was unknown. Half (n = 64/128) of the antepartum stillbirths were unexplained. Two-thirds (67%, n = 87/129) of intrapartum stillbirths followed acute intrapartum events, and 30% (39/129) were unexplained. Of the neonatal deaths, 40% died after complications of intrapartum events.
CONCLUSION
Problems of documentation, lack of perinatal death audits, capacity for investigations, and guidelines for the unambiguous objective assignment of timing and primary causes of death are major threats for accurate determination of timing and specific primary causes of perinatal deaths.
Topics: Adult; Birthing Centers; Cause of Death; Female; Humans; Infant, Newborn; Perinatal Mortality; Pregnancy; Prospective Studies; Tanzania
PubMed: 33444424
DOI: 10.1371/journal.pone.0245196 -
Journal of Perinatal Medicine Jul 2022Stillbirth remains a global public health issue; in low-resource settings stillbirth rates remain high (>12 per 1,000 births target of Every Newborn Action Plan)....
OBJECTIVES
Stillbirth remains a global public health issue; in low-resource settings stillbirth rates remain high (>12 per 1,000 births target of Every Newborn Action Plan). Preeclampsia is major risk factor for stillbirths. This study aimed to determine the prevalence and risk factors for stillbirth amongst women with severe preeclampsia at Mpilo Central Hospital.
METHODS
A retrospective cross-sectional study was conducted of women with severe preeclampsia from 01/01/2016 to 31/12/2018 at Mpilo Central Hospital, Bulawayo, Zimbabwe. Multivariable logistic regression was used to determine risk factors that were independently associated with stillbirths.
RESULTS
Of 469 women that met the inclusion criteria, 46 had a stillbirth giving a stillbirth prevalence of 9.8%. The risk factors for stillbirths in women with severe preeclampsia were: unbooked status (adjusted odds ratio (aOR) 3.01, 95% (confidence interval) CI 2.20-9.10), frontal headaches (aOR 2.33, 95% CI 0.14-5.78), vaginal bleeding with abdominal pain (aOR 4.71, 95% CI 1.12-19.94), diastolic blood pressure ≥150 mmHg (aOR 15.04, 95% CI 1.78-126.79), platelet count 0-49 × 10/L (aOR 2.80, 95% CI 1.26-6.21), platelet count 50-99 × 10/L (aOR 2.48, 95% CI 0.99-6.18), antepartum haemorrhage (aOR 12.71, 95% CI 4.15-38.96), haemolysis elevated liver enzymes syndrome (HELLP) (aOR 6.02, 95% CI 2.22-16.33) and fetal sex (aOR 2.75, 95% CI 1.37-5.53).
CONCLUSIONS
Women with severe preeclampsia are at significantly increased risk of stillbirth. This study has identified risk factors for stillbirth in this high-risk population; which we hope could be used by clinicians to reduce the burden of stillbirths in women with severe preeclampsia.
Topics: Cross-Sectional Studies; Female; Hospitals; Humans; Infant, Newborn; Pre-Eclampsia; Pregnancy; Prevalence; Retrospective Studies; Risk Factors; Stillbirth; Zimbabwe
PubMed: 35618665
DOI: 10.1515/jpm-2022-0080 -
Turkish Journal of Obstetrics and... Mar 2023To assess whether antenatal azithromycin given to pregnant women with vaginal cerclage can reduce preterm birth or not.
OBJECTIVE
To assess whether antenatal azithromycin given to pregnant women with vaginal cerclage can reduce preterm birth or not.
MATERIALS AND METHODS
We randomized 50 pregnant ladies who underwent cerclage at Ain Shams University Maternity Hospital in group A (receiving 500 mg Azithromycin oral tablets (Zithrokan, Hikma, Egypt) one tablet orally twice daily for three days in 3 courses at 14, 24 and 32 week, plus usual antenatal care) and an identical group B (receiving usual antenatal care). Our primary outcome was gestational age at delivery, and secondary outcomes were birthweight, mode of delivery, and maternal, and perinatal complications. This study was registered on ClinicalTrials.gov with number: NCT04278937.
RESULTS
Pregnancy was more prolonged in the Azithromycin group (delivery at 36.8 weeks vs 34.1 weeks; p=0.017). Also, a higher birthweight was observed in the Azithromycin group (2932.6 gm vs 2401.8 gm; p=0.006). No significant difference was found between the two groups as regards to other outcomes (miscarriage, stillbirth, neonatal intensive care unit admission, antepartum hemorrhage, postpartum pyrexia, need for blood transfusion).
CONCLUSION
Adding antenatal azithromycin to women undergoing cerclage prolongs pregnancy and reduces the risk of preterm birth, with a slight increase in birthweight.
PubMed: 36907997
DOI: 10.4274/tjod.galenos.2023.47715