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Ultrasound in Obstetrics & Gynecology :... Jun 2021To determine whether decreased fetal growth velocity precedes antepartum fetal death and to evaluate whether fetal growth velocity is a better predictor of antepartum...
OBJECTIVES
To determine whether decreased fetal growth velocity precedes antepartum fetal death and to evaluate whether fetal growth velocity is a better predictor of antepartum fetal death compared to a single fetal biometric measurement at the last available ultrasound scan prior to diagnosis of demise.
METHODS
This was a retrospective, longitudinal study of 4285 singleton pregnancies in African-American women who underwent at least two fetal ultrasound examinations between 14 and 32 weeks of gestation and delivered a liveborn neonate (controls; n = 4262) or experienced antepartum fetal death (cases; n = 23). Fetal death was defined as death diagnosed at ≥ 20 weeks of gestation and confirmed by ultrasound examination. Exclusion criteria included congenital anomaly, birth at < 20 weeks of gestation, multiple gestation and intrapartum fetal death. The ultrasound examination performed at the time of fetal demise was not included in the analysis. Percentiles for estimated fetal weight (EFW) and individual biometric parameters were determined according to the Hadlock and Perinatology Research Branch/Eunice Kennedy Shriver National Institute of Child Health and Human Development (PRB/NICHD) fetal growth standards. Fetal growth velocity was defined as the slope of the regression line of the measurement percentiles as a function of gestational age based on two or more measurements in each pregnancy.
RESULTS
Cases had significantly lower growth velocities of EFW (P < 0.001) and of fetal head circumference, biparietal diameter, abdominal circumference and femur length (all P < 0.05) compared to controls, according to the PRB/NICHD and Hadlock growth standards. Fetuses with EFW growth velocity < 10 percentile of the controls had a 9.4-fold and an 11.2-fold increased risk of antepartum death, based on the Hadlock and customized PRB/NICHD standards, respectively. At a 10% false-positive rate, the sensitivity of EFW growth velocity for predicting antepartum fetal death was 56.5%, compared to 26.1% for a single EFW percentile evaluation at the last available ultrasound examination, according to the customized PRB/NICHD standard.
CONCLUSIONS
Given that 74% of antepartum fetal death cases were not diagnosed as small-for-gestational age (EFW < 10 percentile) at the last ultrasound examination when the fetuses were alive, alternative approaches are needed to improve detection of fetuses at risk of fetal death. Longitudinal sonographic evaluation to determine growth velocity doubles the sensitivity for prediction of antepartum fetal death compared to a single EFW measurement at the last available ultrasound examination, yet the performance is still suboptimal. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
Topics: Adult; Biometry; Female; Fetal Growth Retardation; Fetal Weight; Gestational Age; Humans; Infant, Newborn; Infant, Small for Gestational Age; Perinatal Death; Predictive Value of Tests; Pregnancy; Retrospective Studies; Sensitivity and Specificity; Ultrasonography, Prenatal; Young Adult
PubMed: 32936481
DOI: 10.1002/uog.23111 -
Placenta Oct 2013Villitis of unknown etiology (VUE) is an inflammatory condition reported to occur in up to 15% of term placentas. It has been reported in association with fetal growth... (Review)
Review
Villitis of unknown etiology (VUE) is an inflammatory condition reported to occur in up to 15% of term placentas. It has been reported in association with fetal growth restriction and antepartum stillbirth. This study aimed to investigate the strength of these associations by completing a systematic review using established guidelines. 618 potentially relevant studies were identified. After exclusion of studies that were not relevant or of insufficient quality, a total of 24 case-control and cohort studies were included in the review. Studies were grouped according to whether their main focus was VUE, fetal growth restriction or stillbirth. A methodological quality assessment carried out for each group demonstrated significant heterogeneity in study design. VUE occurs more frequently in placentas of growth restricted infants. A significant link between VUE and stillbirth could not be reliably established because there were too few published studies. Further research into the pathological effects of VUE using robust protocols and reporting methods is required.
Topics: Chorionic Villi; Female; Fetal Growth Retardation; Humans; Inflammation; Placenta Diseases; Pregnancy; Stillbirth
PubMed: 23906543
DOI: 10.1016/j.placenta.2013.07.003 -
American Journal of Epidemiology Jun 1993Data from married women who participated in the 1980 National Natality Survey and the National Fetal Mortality Survey were used for a case-control study of antepartum...
Data from married women who participated in the 1980 National Natality Survey and the National Fetal Mortality Survey were used for a case-control study of antepartum and intrapartum stillbirth. Risk factors were identified by comparing antepartum deaths and intrapartum deaths to livebirths in separate logistic regression analyses. Risk of antepartum death was increased among black mothers, those having their first delivery, those aged 35 years or more, and those with less education. Smoking cigarettes was associated with increased risk. For intrapartum deaths, total abstention from alcohol during pregnancy was associated with increased risk in the best-fitting logistic model, as was first delivery. Body mass index was logit-linear in both models, with lower body mass index associated with lower risk. While some of these factors have already been associated with stillbirth, others have not; the new associations may reflect the continuum of loss over the gestational period, bias in the study, or clues to mechanisms by which the risk of death, before or during parturition, is increased.
Topics: Adult; Alcohol Drinking; Body Weight; Case-Control Studies; Educational Status; Female; Fetal Death; Humans; Infant Mortality; Infant, Newborn; Maternal Age; Obstetric Labor Complications; Odds Ratio; Pregnancy; Racial Groups; Risk Factors; United States
PubMed: 8322759
DOI: 10.1093/oxfordjournals.aje.a116620 -
L'Encephale Dec 2010The occurrence of depression during pregnancy is a frequent situation that must be distinguished from postpartum depression. It raises many questions regarding its... (Review)
Review
INTRODUCTION
The occurrence of depression during pregnancy is a frequent situation that must be distinguished from postpartum depression. It raises many questions regarding its complications and therapeutic options.
OBJECTIVES
To provide a systematic review of available data on prevalence, risk factors, and adverse outcomes of antepartum depression, as well as on screening tools and treatments currently available.
METHODS
Studies, reviews, and meta-analyses were searched through the Pubmed and Embase databases. Articles related to postpartum depression or specifically focusing on bipolar disorder were excluded.
EPIDEMIOLOGY
Prevalence is estimated between 5 and 15%. Risk factors, in addition to those of any depression, are an ambivalent attitude towards pregnancy, previous miscarriages, and medically-assisted or complicated pregnancies. Diagnosis and screening: No specific tool has yet been designed to diagnose or screen antepartum depression, but some scales (EPDS, PRIME-MD PHQ) have been validated. Adverse outcomes: For the mother, adverse outcomes are those of any depression, in addition to an increased risk of delivery complications and of postpartum depression. For the child, there is an increased risk for preterm birth, low birth-weight, and possibly sudden death.
TREATMENTS
- Tricyclic antidepressants are widely described as safe during pregnancy. SSRIs show much reassuring data, even though recent studies have raised concerns about cardiac malformations and persistent pulmonary hypertension of the newborn. Electroconvulsive therapy is only indicated in the most severe cases but appears secure under specific safety measures. Most psychotherapies have not been specifically assessed during pregnancy. Other treatments (bright light therapy, rTMS…) have shown some promising but not robust results.
CONCLUSION
Antepartum depression is frequent, and potentially severe if not treated. Validation of specific screening tools is warranted. Pharmacological treatment should not be postponed in cases of severe depression. Regarding moderate depressions, it appears reasonable to turn to non-pharmacological treatments, primarily psychotherapies, which therefore should be more thoroughly studied.
Topics: Antidepressive Agents; Combined Modality Therapy; Cross-Sectional Studies; Depression, Postpartum; Depressive Disorder; Electroconvulsive Therapy; Female; Humans; Infant, Low Birth Weight; Infant, Newborn; Mass Screening; Obstetric Labor, Premature; Pregnancy; Pregnancy Complications; Prognosis; Psychotherapy; Risk Factors; Stillbirth
PubMed: 21130227
DOI: 10.1016/j.encep.2010.02.004 -
Reproductive Health Oct 2023In Cambodia, stillbirths and their underlying factors have not been systematically studied. This study aimed to assess the proportion and trends in stillbirths between...
Stillbirth rates and their determinants in a national maternity hospital in Phnom Penh, Cambodia in 2017-2020: a cross-sectional assessment with a nested case-control study.
BACKGROUND
In Cambodia, stillbirths and their underlying factors have not been systematically studied. This study aimed to assess the proportion and trends in stillbirths between 2017 and 2020 in a large maternity referral hospital in the country and identify their key determinants to inform future prevention efforts.
METHODS
This was a retrospective cross-sectional analysis with a nested case-control study of women giving birth at the National Maternal and Child Health Centre (NMCHC) in Phnom Penh, 2017-2020. We calculated percentages of singleton births at ≥ 22 weeks' gestation resulting in stillbirth and annual stillbirth rates by timing: intrapartum (fresh) or antepartum (macerated). Multivariable logistic regression was used to explore factors associated with stillbirth, where cases were all women who gave birth to a singleton stillborn baby in the 4-year period. One singleton live birth immediately following each case served as an unmatched control. Multiple imputation was used to handle missing data for gestational age.
RESULTS
Between 2017 and 2020, 3.2% of singleton births ended in stillbirth (938/29,742). The stillbirth rate increased from 24.8 per 1000 births in 2017 to 38.1 per 1000 births in 2020, largely due to an increase in intrapartum stillbirth rates which rose from 18.8 to 27.4 per 1000 births in the same period. The case-control study included 938 cases (stillbirth) and 938 controls (livebirths). Factors independently associated with stillbirth were maternal age ≥ 35 years compared to < 20 years (aOR: 1.82, 95%CI: 1.39, 2.38), extreme (aOR: 3.29, 95%CI: 2.37, 4.55) or moderate (aOR: 2.45, 95%CI: 1.74, 3.46) prematurity compared with full term, and small-for-gestational age (SGA) (aOR: 2.32, 1.71, 3.14) compared to average size-for-age. Breech/transverse births had nearly four times greater odds of stillbirth (aOR: 3.84, 95%CI: 2.78, 5.29), while caesarean section reduced the odds by half compared with vaginal birth (aOR: 0.50, 95%CI: 0.39, 0.64). A history of abnormal vaginal discharge increased odds of stillbirth (aOR: 1.42, 95%CI: 1.11, 1.81) as did a history of stillbirth (aOR: 3.08, 95%CI: 1.5, 6.5).
CONCLUSIONS
Stillbirth prevention in this maternity referral hospital in Cambodia requires strengthening preterm birth detection and management of SGA, intrapartum care, monitoring women with stillbirth history, management of breech births, and further investigation of high-risk referral cases.
Topics: Child; Pregnancy; Female; Infant, Newborn; Humans; Adult; Stillbirth; Case-Control Studies; Cross-Sectional Studies; Retrospective Studies; Cesarean Section; Cambodia; Hospitals, Maternity; Premature Birth; Fetal Growth Retardation
PubMed: 37865789
DOI: 10.1186/s12978-023-01703-y -
Obstetrical & Gynecological Survey Nov 2005The objective of this study was to determine the prevalence, adverse pregnancy complications, and optimal management of pregnancies complicated by bleeding in the second... (Review)
Review
UNLABELLED
The objective of this study was to determine the prevalence, adverse pregnancy complications, and optimal management of pregnancies complicated by bleeding in the second half of pregnancy of an unknown origin (ABUO). A MEDLINE search from 1966 through November 2004 using the search terms "antepartum hemorrhage" or "hemorrhage" or "uterine hemorrhage" and "pregnancy complications" and "cardiovascular complications" and "second trimester pregnancy" or "third trimester pregnancy" was undertaken. The inclusion criteria focused on bleeding not resulting from placenta previa or abruption or to any known cause. The MEDLINE search provided 24 abstracts for review with 9 studies meeting the inclusion criteria The prevalence of ABUO was 2%. The likelihood of antepartum hemorrhage and delivery before 37 weeks was significant with an odds ratio (OR) of 3.17 and 95% confidence interval (CI) of 2.76-3.64. The risk of intrauterine fetal demise was significantly increased in women with ABUO (OR, 2.09; 95% CI, 1.43-3.06). The association between ABUO and fetal anomalies was increased with an OR 1.42 (95% CI, 1.07-1.87). Only one study with a small sample size (N = 48) compared the outcomes of women using Doppler studies of the umbilical and uterine arteries and biophysical profiles. No differences were observed in the women undergoing antenatal testing and the women not undergoing antenatal testing. The prevalence of ABUO is 2%. Preterm delivery, stillbirth, and fetal anomalies appear to be increased in these pregnancies. Antenatal testing may be of limited value in their management.
TARGET AUDIENCE
Obstetricians & Gynecologists, Family Physicians Learning Objectives: After completion of this article, the reader should be able to explain the prevalence of antepartum bleeding of unknown origin (ABUO) in confronting a patient with ABUO, summarize the types and frequency of adverse pregnancy outcomes in ABUO, and recall the limited usefulness of antenatal testing in patients with ABUO.
Topics: Adult; Female; Fetal Death; Hemorrhage; Humans; Odds Ratio; Pregnancy; Pregnancy Complications; Pregnancy Trimester, Second; Pregnancy Trimester, Third; Prevalence; Prognosis; Risk Factors
PubMed: 16250922
DOI: 10.1097/01.ogx.0000182881.53139.f7 -
Seminars in Perinatology Aug 2008Maternal perception of fetal movements is the oldest and most commonly used method to assess fetal well-being. While almost all pregnant women adhere to it, organized... (Review)
Review
Maternal perception of fetal movements is the oldest and most commonly used method to assess fetal well-being. While almost all pregnant women adhere to it, organized screening by fetal movements has seen variable popularity among health professionals. Early results of screening were promising and fetal movement counting is the only antepartum testing method that has shown effect in reducing mortality in a randomized controlled trial comparing testing versus no testing. Although awareness of fetal movements is associated with improved perinatal outcomes, the quest to define a quantitative "alarm limit" to define decreased fetal movements has so far been unsuccessful, and the use of most such limits developed for fetal movement counting should be discouraged.
Topics: Female; Fetal Death; Fetal Movement; Humans; Pregnancy; Stillbirth
PubMed: 18652921
DOI: 10.1053/j.semperi.2008.04.004 -
Frontiers in Pediatrics 2022Stillbirth, which accounts for half of all the perinatal mortality, is not counted on policy, program, and investment agendas around the globe. It has been...
BACKGROUND
Stillbirth, which accounts for half of all the perinatal mortality, is not counted on policy, program, and investment agendas around the globe. It has been underestimated public health burden, particularly in developing countries. Ethiopia is among the top countries with a large prevalence of stillbirth in the world. However, there is a dearth of study on the current magnitude of stillbirth in the study area. Therefore, this study intended to assess the prevalence of stillbirth and its associated factors to bridge the gap.
METHODS
A hospital-based retrospective study was conducted from 1 to 28 February 2019 and data were collected by reviewing the chart records of all the women who gave birth in the past 2 years (January 2016 to December 2018) at Hiwot Fana Specialized University Hospital. Data were entered into EpiData version 4.2.0.0 software and transported to SPSS version 23 for analysis. Descriptive statistics such as frequency, mean, and SDs were generated. Determinants of stillbirth were analyzed using a binary logistic regression and presented by adjusted odds ratio (AOR) with a 95% CI.
RESULTS
The prevalence of stillbirth was 14.5% (95% CI: 11.7%, 17.6%). Low birth weight (AOR = 2.42, 95% CI: 1.23-4.76), prematurity (AOR = 2.10, 95% CI: 1.10-4.01), premature rupture of membranes (AOR = 2.08, 95% CI: 1.14-3.77), antepartum hemorrhage (AOR = 3.33, 95% CI: 1.66-6.67), obstructed labor (AOR = 2.87, 95% CI: 1.48-5.56), and preeclampsia (AOR = 2.91, 95% CI: 1.28-6.62) were an independently associated with stillbirth.
CONCLUSION
The prevalence of stillbirth in this study was high. Low birth weight, preterm birth, premature rupture of membranes, antepartum hemorrhage, obstructed labor, and preeclampsia were independently associated with a stillbirth. Therefore, much study is needed involving different stakeholders to reduce stillbirths by improving the health status of women through the provision of quality maternal care including referral systems.
PubMed: 35633972
DOI: 10.3389/fped.2022.820308 -
Journal of Obstetrics and Gynaecology... Dec 2021Attempts to reduce the current rate of antepartum stillbirth in the late third trimester have largely focused on the accurate identification of fetal growth restriction....
BACKGROUND
Attempts to reduce the current rate of antepartum stillbirth in the late third trimester have largely focused on the accurate identification of fetal growth restriction. Universal ultrasound significantly increases detection, especially when combined with maternal angiogenic growth factors, but this screening strategy is not well suited to identify umbilical cord pathology. While this poses unique challenges to pregnancy care, the recurrence risk of cord obstruction is low in comparison with many intrinsic placental diseases.
CASE
A 30-year-old woman with normal uterine artery Doppler waveforms, fetal growth ultrasounds, and circulating placental growth factor experienced an unexpected third-trimester stillbirth. Placental pathology demonstrated fetal vascular malperfusion and cord hyper-coiling.
CONCLUSION
Despite normal placental function, the otherwise healthy fetus is at risk of antepartum stillbirth due to cord-related pathology.
Topics: Adult; Female; Fetal Growth Retardation; Humans; Placenta; Placenta Growth Factor; Pregnancy; Stillbirth; Uterine Artery
PubMed: 34411727
DOI: 10.1016/j.jogc.2021.07.019 -
American Journal of Perinatology May 2015We have previously shown a decrease in the overall stillbirth rate at our institution in women receiving the seasonal influenza vaccine during pregnancy. The goal of... (Comparative Study)
Comparative Study
OBJECTIVE
We have previously shown a decrease in the overall stillbirth rate at our institution in women receiving the seasonal influenza vaccine during pregnancy. The goal of this study was to ascertain factors associated with this decrease.
STUDY DESIGN
This was a retrospective cohort study examining the stillbirth rate, etiology, autopsy findings, and placental pathology in pregnant women receiving the seasonal trivalent inactive influenza vaccine during five influenza seasons between 2003 and 2008. All stillbirths at our institution are investigated by a committee and an etiology is assigned. Autopsy is offered to all patients and placental evaluation is performed routinely.
RESULTS
During the study period, 8,690 pregnant women received the seasonal influenza vaccine antepartum and delivered at our institution. Thirty of these births were complicated by stillbirth as compared with 436 stillbirths in the 76,153 women not vaccinated (0.35 vs. 0.57%, p = 0.006). No association was identified between assigned causes of stillbirth when comparing vaccinated and nonvaccinated women.
CONCLUSION
No specific etiology commonly associated with stillbirth was identified to have been affected by maternal antepartum influenza vaccination.
Topics: Adolescent; Adult; Female; Humans; Influenza Vaccines; Influenza, Human; Logistic Models; Placenta; Pregnancy; Pregnancy Complications, Infectious; Retrospective Studies; Stillbirth; Vaccination; Young Adult
PubMed: 25607230
DOI: 10.1055/s-0034-1544046