-
BMC Pregnancy and Childbirth Feb 2024The causes of some stillbirths are unclear, and additional work must be done to investigate the risk factors for stillbirths.
BACKGROUND
The causes of some stillbirths are unclear, and additional work must be done to investigate the risk factors for stillbirths.
OBJECTIVE
To apply the International Classification of Disease-10 (ICD-10) for antepartum stillbirth at a referral center in eastern China.
METHODS
Antepartum stillbirths were grouped according to the cause of death according to the International Classification of Disease-10 (ICD-10) criteria. The main maternal condition at the time of antepartum stillbirth was assigned to each patient.
RESULTS
Antepartum stillbirths were mostly classified as fetal deaths of unspecified cause, antepartum hypoxia. Although more than half of the mothers were without an identified condition at the time of the antepartum stillbirth, where there was a maternal condition associated with perinatal death, maternal medical and surgical conditions and maternal complications during pregnancy were most common. Of all the stillbirths, 51.2% occurred between 28 and 37 weeks of gestation, the main causes of stillbirth at different gestational ages also differed. Autopsy and chromosomal microarray analysis (CMA) were recommended in all stillbirths, but only 3.6% received autopsy and 10.5% underwent chromosomal microarray analysis.
CONCLUSIONS
The ICD-10 is helpful in classifying the causes of stillbirths, but more than half of the stillbirths in our study were unexplained; therefore, additional work must be done. And the ICD-10 score may need to be improved, such as by classifying stillbirths according to gestational age. Autopsy and CMA could help determine the cause of stillbirth, but the acceptance of these methods is currently low.
Topics: Pregnancy; Female; Humans; Stillbirth; Retrospective Studies; International Classification of Diseases; Fetal Death; Referral and Consultation; Cause of Death
PubMed: 38408955
DOI: 10.1186/s12884-024-06313-5 -
BMC Pregnancy and Childbirth Jul 2020Lack of a unified and comparable classification system to unravel the underlying causes of stillbirth hampers the development and implementation of targeted... (Observational Study)
Observational Study
BACKGROUND
Lack of a unified and comparable classification system to unravel the underlying causes of stillbirth hampers the development and implementation of targeted interventions to reduce the unacceptably high stillbirth rates (SBR) in sub-Saharan Africa. Our aim was to track the SBR and the predominant maternal and fetal causes of stillbirths using the WHO ICD-PM Classification system.
METHODS
This was a retrospective observational study in a major referral centre in northeast Nigeria between 2010 and 2018. Specialist Obstetricians and Gynaecologists assigned causes of stillbirths after an extensive audit of available stillbirths' records. Cause of death was assigned via consensus using the ICD-PM classification system.
RESULTS
There were 21,462 births between 1 January 2010 and 31 December 2018 in our study setting; of these, 1177 culminated in stillbirths with a total hospital SBR of 55 per 1000 births (95% CI: 52, 58). There were two peaks of stillbirths in 2012 [62 per 1000 births (95% CI: 53, 71)], and 2015 [65 per 1000 births (95% CI, 55, 76)]. Antepartum and intrapartum stillbirths were almost equally prevalent (48% vs 52%). Maternal medical and surgical conditions (M4) were the commonest (69.3%) cause of antepartum stillbirths while complications of placenta, cord and membranes (M3) accounted for the majority (45.8%) of intrapartum stillbirths and the trends were similar between 2010 and 2018. Antepartum and intrapartum fetal causes of stillbirths were mainly due to prematurity which is a disorder of fetal growth (A5 and I6).
CONCLUSIONS
Most causes of stillbirths in our setting are due to preventable causes and the trends have remained unabated between 2010 and 2018. Progress toward global SBR targets are off-track, requiring more interventions to halt and reduce the high SBR.
Topics: Birth Weight; Cause of Death; Female; Gestational Age; Humans; International Classification of Diseases; Nigeria; Pregnancy; Referral and Consultation; Retrospective Studies; Stillbirth; World Health Organization
PubMed: 32611330
DOI: 10.1186/s12884-020-03059-8 -
Journal of Perinatal Medicine Jul 2022We compared delivery characteristics and outcome of women with stillbirth to those with live birth.
OBJECTIVES
We compared delivery characteristics and outcome of women with stillbirth to those with live birth.
METHODS
This was a retrospective case-control study from Helsinki University Hospital, Finland. The study population comprised 214 antepartum singleton stillbirths during 2003-2015. Two age-adjusted controls giving live birth in the same year at the same institution were chosen for each case from the Finnish Medical Birth Register. Delivery characteristics and adverse pregnancy outcomes were compared between the cases and controls, adjusted for gestational age.
RESULTS
Labor induction was more common (86.0 vs. 22.0%, p<0.001, gestational age adjusted odds ratio [aOR] 35.25, 95% confidence interval [CI] 12.37-100.45) and cesarean sections less frequent (9.3 vs. 28.7%, p<0.001, aOR 0.21, 95% CI 0.10-0.47) among women with stillbirth. Duration of labor was significantly shorter among the cases (first stage 240.0 min [115.0-365.0 min] vs. 412.5 min [251.0-574.0 min], p<0.001; second stage 8.0 min [0.0-16.0 min] vs. 15.0 min [4.0-26.0 min], p<0.001). Placental abruption was more common in pregnancies with stillbirth (15.0 vs. 0.9%, p<0.001, aOR 8.52, 95% CI 2.51-28.94) and blood transfusion was needed more often (10.7 vs. 4.4%, p=0.002, aOR 6.5, 95% CI 2.10-20.13). The rates of serious maternal complications were low.
CONCLUSIONS
Most women with stillbirth delivered vaginally without obstetric complications. The duration of labor was shorter in pregnancies with stillbirth but the risk for postpartum interventions and bleeding complications was higher compared to those with live birth.
Topics: Case-Control Studies; Female; Hospitals, Teaching; Humans; Placenta; Pregnancy; Retrospective Studies; Stillbirth
PubMed: 33629576
DOI: 10.1515/jpm-2020-0573 -
BMC Pregnancy and Childbirth Dec 2023Globally, more than 2.6 million stillbirths occur each year. The vast majority (98%) of stillbirths occur in low- and middle-income countries, and over fifty percent... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Globally, more than 2.6 million stillbirths occur each year. The vast majority (98%) of stillbirths occur in low- and middle-income countries, and over fifty percent (55%) of these happen in rural sub-Saharan Africa.
METHODS
This is a systematic review and meta-analysis developed using the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. A literature search was performed using PubMed, the Cochrane Library, Google Scholar, EMBASE, Scopus, the Web of Sciences, and gray literature. Rayyan`s software was used for literature screening. A random effects meta-analysis was conducted with STATA version 17. Heterogeneity was checked by using Cochran's Q and I2 tests. Funnel plots and Egger's test were used to examine the risk of publication bias. The protocol of the study was registered in PROSPERO with a registration number of CRD42023391874.
RESULTS
Forty-one studies gathered from eight sub-Saharan countries with a total of 192,916 sample sizes were included. Nine variables were highly linked with stillbirth. These include advanced maternal age (aOR: 1.43, 95% CI: 1.16, 1.70), high educational attainment (aOR: 0.55, 95% CI: 0.47, 0.63), antenatal care (aOR: 0.45, 95% CI: 0.35, 0.55), antepartum hemorrhage (aOR: 2.70, 95% CI: 1.91, 3.50), low birth weight (aOR: 1.72, 95% CI: 1.56-1.87), admission by referral (aOR: 1.55, 95% CI: 1.41, 1.68), history of stillbirth (aOR: 2.43, 95% CI: 1.84, 3.03), anemia (aOR: 2.62, 95% CI: 1.93, 3.31), and hypertension (aOR: 2.22, 95% CI: 1.70, 2.75).
CONCLUSION
A significant association was found between stillbirth and maternal age, educational status, antenatal care, antepartum hemorrhage, birth weight, mode of arrival, history of previous stillbirth, anemia, and hypertension. Integrating maternal health and obstetric factors will help identify the risk factors as early as possible and provide early interventions.
Topics: Pregnancy; Female; Humans; Stillbirth; Hypertension; Africa South of the Sahara; Anemia; Hemorrhage; Prevalence
PubMed: 38049743
DOI: 10.1186/s12884-023-06148-6 -
BMJ Open Mar 2024Obesity increases risk of pre-eclampsia, but the association with haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome is understudied.
Prepregnancy body mass index and other risk factors for early-onset and late-onset haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome: a population-based retrospective cohort study in British Columbia, Canada.
BACKGROUND
Obesity increases risk of pre-eclampsia, but the association with haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome is understudied.
OBJECTIVE
To examine the association between prepregnancy body mass index (BMI) and HELLP syndrome, including early-onset versus late-onset disease.
STUDY DESIGN
A retrospective cohort study using population-based data.
SETTING
British Columbia, Canada, 2008/2009-2019/2020.
POPULATION
All pregnancies resulting in live births or stillbirths at ≥20 weeks' gestation.
METHODS
BMI categories (kg/m) included underweight (<18.5), normal (18.5-24.9), overweight (25.0-29.9) and obese (≥30.0). Rates of early-onset and late-onset HELLP syndrome (<34 vs ≥34 weeks, respectively) were calculated per 1000 ongoing pregnancies at 20 and 34 weeks' gestation, respectively. Cox regression was used to assess the associations between risk factors (eg, BMI, maternal age and parity) and early-onset versus late-onset HELLP syndrome.
MAIN OUTCOME MEASURES
Early-onset and late-onset HELLP syndrome.
RESULTS
The rates of HELLP syndrome per 1000 women were 2.8 overall (1116 cases among 391 941 women), and 1.9, 2.5, 3.2 and 4.0 in underweight, normal BMI, overweight and obese categories, respectively. Overall, gestational age-specific rates of HELLP syndrome increased with prepregnancy BMI. Obesity (compared with normal BMI) was more strongly associated with early-onset HELLP syndrome (adjusted HR (AHR) 2.24 (95% CI 1.65 to 3.04) than with late-onset HELLP syndrome (AHR 1.48, 95% CI 1.23 to 1.80) (p value for interaction 0.025). Chronic hypertension, multiple gestation, bleeding (<20 weeks' gestation and antepartum) also showed differing AHRs between early-onset versus late-onset HELLP syndrome.
CONCLUSIONS
Prepregnancy BMI is positively associated with HELLP syndrome and the association is stronger with early-onset HELLP syndrome. Associations with early-onset and late-onset HELLP syndrome differed for some risk factors, suggesting possible differences in aetiological mechanisms.
Topics: Pregnancy; Female; Humans; Retrospective Studies; HELLP Syndrome; Overweight; Body Mass Index; British Columbia; Thinness; Hemolysis; Risk Factors; Obesity; Pre-Eclampsia; Liver
PubMed: 38521522
DOI: 10.1136/bmjopen-2023-079131 -
Journal of Global Health Aug 2022The World Health Organization launched the International Classification of Diseases for Perinatal Mortality (ICD-PM) in 2016 to uniformly report on the causes of...
BACKGROUND
The World Health Organization launched the International Classification of Diseases for Perinatal Mortality (ICD-PM) in 2016 to uniformly report on the causes of perinatal deaths. In this systematic review, we aim to describe the global use of the ICD-PM by reporting causes of perinatal mortality and summarizing challenges and suggested amendments.
METHODS
We systematically searched MEDLINE, Embase, Global Health, and CINAHL databases using key terms related to perinatal mortality and the classification for causes of death. We included studies that applied the ICD-PM and were published between January 2016 and June 2021. The ICD-PM data were extracted and a qualitative analysis was performed to summarize the challenges of the ICD-PM. We applied the PRISMA guidelines, registered our protocol at PROSPERO [CRD42020203466], and used the Appraisal tool for Cross-Sectional Studies (AXIS) as a framework to evaluate the quality of evidence.
RESULTS
The search retrieved 6599 reports. Of these, we included 15 studies that applied the ICD-PM to 44 900 perinatal deaths. Most causes varied widely; for example, "antepartum hypoxia" was the cause of stillbirths in 0% to 46% (median = 12%, n = 95) in low-income settings, 0% to 62% (median = 6%, n = 1159) in middle-income settings and 0% to 55% (median = 5%, n = 249) in high-income settings. Five studies reported challenges and suggested amendments to the ICD-PM. The most frequently reported challenges included the high proportion of antepartum deaths of unspecified cause (five studies), the inability to determine the cause of death when the timing of death is unknown (three studies), and the challenge of assigning one cause in case of multiple contributing conditions (three studies).
CONCLUSIONS
The ICD-PM is increasingly being used across the globe and gives health care providers insight into the causes of perinatal death in different settings. However, there is wide variation in reported causes of perinatal death across comparable settings, which suggests that the ICD-PM is applied inconsistently. We summarized the suggested amendments and made additional recommendations to improve the use of the ICD-PM and help strengthen its consistency.
REGISTRATION
PROSPERO [CRD42020203466].
Topics: Female; Humans; Pregnancy; Cause of Death; Cross-Sectional Studies; International Classification of Diseases; Perinatal Death; Perinatal Mortality; Stillbirth; Infant, Newborn
PubMed: 35972943
DOI: 10.7189/jogh.12.04069 -
Scientific Reports Dec 2021To investigate whether earlier "post-term" monitoring of South Asian (SA) pregnancies from 39 weeks' gestation with amniotic fluid index (AFI) and cardiotocography...
To investigate whether earlier "post-term" monitoring of South Asian (SA) pregnancies from 39 weeks' gestation with amniotic fluid index (AFI) and cardiotocography (CTG) detected suspected fetal compromise. Retrospective cohort study of all SA-born women at an Australian health service with uncomplicated, singleton pregnancies following the introduction of twice-weekly AFI and CTG monitoring from 39 weeks. Monitoring results, and their association with a perinatal compromise composite (including assisted delivery for fetal compromise, stillbirth, and NICU admission) were determined. 771 SA-born women had earlier monitoring, triggering delivery in 82 (10.6%). 31 (4%) had a non-reassuring antepartum CTG (abnormal fetal heart rate or variability, or decelerations) and 21 (2.7%) had an abnormal AFI (≤ 5 cm). Women with abnormal monitoring were 53% (95% CI 1.2-1.9) more likely to experience perinatal compromise and 83% (95% CI 1.2-2.9) more likely to experience intrapartum compromise than women with normal monitoring. Monitoring from 39 weeks identified possible fetal compromise earlier than it otherwise would have been, and triggered intervention in 10% of women. Without robust evidence to guide timing of birth in SA-born women to reduce rates of stillbirth, earlier monitoring provides an alternative to routine induction of labour.
Topics: Adult; Amniotic Fluid; Asian People; Australia; Cardiotocography; Delivery, Obstetric; Female; Fetal Distress; Fetal Monitoring; Gestational Age; Heart Rate, Fetal; Humans; Infant, Newborn; Pregnancy; Pregnancy Complications; Prenatal Diagnosis; Retrospective Studies; Stillbirth
PubMed: 34857850
DOI: 10.1038/s41598-021-02836-5 -
Translational Animal Science Jul 2020Climate change causes rising temperatures and extreme weather events worldwide, with possible detrimental time-lagged and acute impact on production and functional...
Climate change causes rising temperatures and extreme weather events worldwide, with possible detrimental time-lagged and acute impact on production and functional traits of cattle kept in outdoor production systems. The aim of the present study was to infer the influence of mean daily temperature humidity index (mTHI) and number of heat stress days (nHS) from different recording periods on birth weight (BWT), 200 d- and 365 d-weight gain (200 dg, 365 dg) of calves, and on the probability of stillbirth (SB), and calving interval (CINT) of their dams. Data recording included 4,362 observations for BWT, 3,136 observations for 200 dg, 2,502 observations for 365 dg, 9,293 observations for the birth status, and 2,811 observations for CINT of the local dual-purpose cattle breed "Rotes Höhenvieh" (RHV). Trait responses on mTHI and nHS were studied via generalized linear mixed model applications with identity link functions for Gaussian traits (BWT, 200 dg, 365 dg, CINT) and logit link functions for binary SB. High mTHI and high nHS before autumn births had strongest detrimental impact on BWT across all antepartum- (a.p.) periods (34.4 ± 0.79 kg maximum). Prolonged CINT was observed when cows suffered heat stress (HS) before or after spring calvings, with maximum length of 391.6 ± 3.82 d (56 d a.p.-period). High mTHI and high nHS during the 42 d- and 56 d a.p.-period implied increased probabilities for SB. We found a significant ( < 0.05) seasonal effect on SB in model 3 across all a.p.-periods, with the highest probability in autumn (maximum of 5.4 ± 0.82% in the 7 d a.p.-period). Weight gains of calves (200 dg and 365 dg) showed strongest HS response for mTHI and nHS measurements from the long-term postnatal periods (42 d- and 56 d-periods), with minimum 200 dg of 194.2 ± 4.15 kg (nHS of 31 to 42 d in the 42 d-period) or minimum 365 dg of 323.8 ± 3.82 kg (mTHI ≥ 60 in the 42 d-period). Calves born in summer, combined with high mTHI or high nHS pre- or postnatal, had lower weight gains, compared with calves born in other calving seasons or under cooler conditions. Highest BWT, weight gains, and shortest CINT mostly were detected under cool to moderate climate conditions for mTHI, and small to moderate nHS. Results indicate acute and time-lagged HS effects and address possible HS-induced epigenetic modifications of the bovine genome across generations and limited acclimatization processes to heat, especially when heat occurs during the cooler spring and autumn months.
PubMed: 33033792
DOI: 10.1093/tas/txaa148 -
Obstetric Medicine Dec 2022Intrahepatic cholestasis of pregnancy (ICP) is a complex liver disease with varying incidence worldwide. We compared ICP incidence and pregnancy outcomes with outcomes...
BACKGROUND
Intrahepatic cholestasis of pregnancy (ICP) is a complex liver disease with varying incidence worldwide. We compared ICP incidence and pregnancy outcomes with outcomes for normal pregnant controls.
METHODS
We conducted a retrospective data analysis of perinatal registry data for the years 2011 and 2017 to compare the following outcome measures: stillbirths, labour induction, gestational diabetes, pre-eclampsia, antepartum haemorrhage, postpartum haemorrhage, preterm births, low Apgar score, acute neonatal respiratory morbidity, meconium aspiration and in-hospital neonatal death.
RESULTS
The incidence of ICP was 8 per 1000 births from a total 31,493 singleton births with more cases in 2017 than in 2011. Women with ICP were almost six times more likely to have labour induced including significantly more moderate preterm births (defined as between 32 weeks and 36 weeks and 6 days of gestation)) seen more in 2011 than in 2017.
CONCLUSION
Women with ICP showed higher incidence of moderate preterm birth and induced labour but favourable maternal and neonatal outcomes.
PubMed: 36523882
DOI: 10.1177/1753495X211058321 -
Acta Obstetricia Et Gynecologica... Jun 2023Perinatal management of extremely preterm births in Sweden has changed toward active care from 22-23 gestational weeks during the last decades. However, considerable...
Changes in perinatal management and outcomes of extremely preterm infants born below 26 weeks of gestation in a tertiary referral hospital in Sweden: Comparison between 2004-2007 and 2012-2016.
INTRODUCTION
Perinatal management of extremely preterm births in Sweden has changed toward active care from 22-23 gestational weeks during the last decades. However, considerable regional differences exist. This study evaluates how one of the largest perinatal university centers has adapted to a more active care between 2004-2007 and 2012-2016 and if this has influenced infant survival.
MATERIAL AND METHODS
In this historical cohort study, women admitted with at least one live fetus and delivered at 22-25 gestational weeks (stillbirths included) at Karolinska University Hospital Solna during April 1, 2004-March 31, 2007, and January 1, 2012-December 31, 2016, were compared regarding rates of obstetric and neonatal interventions, and infant mortality and morbidity. Maternal, pregnancy and infant data from 2004-2007 were obtained from the Extreme Preterm Infants in Sweden Study while data from 2012-2016 were extracted from medical journals and quality registers. The same definitions of interventions and diagnoses were used for both study periods.
RESULTS
A total of 106 women with 118 infants during 2004-2007 and 213 women with 240 infants during 2012-2016 were included. Increases between the study periods were seen regarding cesarean delivery (overall rate 14% [17/118] during 2004-2007 vs. 45% [109/240] during 2012-2016), attendance of a neonatologist at birth (62% [73/118] vs. 85% [205/240]) and surfactant treatment at birth in liveborn infants (60% [45/75] vs. 74% [157/211]). Antepartum stillbirth rate decreased (13% [15/118] vs. 5% [12/240]) and the proportion of live births increased (80% [94/118] vs. 88% [211/240]) while 1-year survival (64% [60/94] vs. 67% [142/211]) and 1-year survival without major neonatal morbidity (21% [20/94] vs. 21% [44/211]) among liveborn infants did not change between the study periods. At 22 gestational weeks, interventions rates were still low during 2012-2016, most obvious regarding antenatal steroid treatment (23%), attendance of a neonatologist (51%), and intubation at birth (24%).
CONCLUSIONS
Both obstetric and neonatal interventions at births below 26 gestational weeks increased between 2004-2007 and 2012-2016 in this single center study; however, at 22 gestational weeks they were still at a low level during 2012-2016. Despite more infants being born alive, 1-year survival did not increase between the study periods.
Topics: Infant; Infant, Newborn; Female; Pregnancy; Humans; Infant, Extremely Premature; Cohort Studies; Tertiary Care Centers; Sweden; Infant, Premature, Diseases; Gestational Age; Infant Mortality; Parturition; Stillbirth
PubMed: 37212521
DOI: 10.1111/aogs.14576