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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 -
BMJ Open Nov 2021To describe the epidemiology of uterine rupture in China from 2015 to 2016 and to build a prediction model for uterine rupture in women with a scarred uterus.
OBJECTIVES
To describe the epidemiology of uterine rupture in China from 2015 to 2016 and to build a prediction model for uterine rupture in women with a scarred uterus.
SETTING
A multicentre cross-sectional survey conducted in 96 hospitals across China in 2015-2016.
PARTICIPANTS
Our survey initially included 77 789 birth records from hospitals with 1000 or more deliveries per year. We excluded 2567 births less than 24 gestational weeks or unknown and 1042 births with unknown status of uterine rupture, leaving 74 180 births for the final analysis.
PRIMARY AND SECONDARY OUTCOME MEASURES
Complete and incomplete uterine rupture and the risk factors, and a prediction model for uterine rupture in women with scarred uterus (assigned each birth a weight based on the sampling frame).
RESULTS
The weighted incidence of uterine rupture was 0.18% (95% CI 0.05% to 0.23%) in our study population during 2015 and 2016. The weighted incidence of uterine rupture in women with scarred and intact uterus was 0.79% (95% CI 0.63% to 0.91%) and 0.05% (95% CI 0.02% to 0.13%), respectively. Younger or older maternal age, prepregnancy diabetes, overweight or obesity, complications during pregnancy (hypertensive disorders in pregnancy and gestational diabetes), low education, repeat caesarean section (≥2), multiple abortions (≥2), assisted reproductive technology, placenta previa, induce labour, fetal malpresentation, multiple pregnancy, anaemia, high parity and antepartum stillbirth were associated with an increased risk of uterine rupture. The prediction model including eight variables (OR >1.5) yielded an area under the curve (AUC) of 0.812 (95% CI 0.793 to 0.836) in predicting uterine rupture in women with scarred uterus with sensitivity and specificity of 77.2% and 69.8%, respectively.
CONCLUSIONS
The incidence of uterine rupture was 0.18% in this population in 2015-2016. The predictive model based on eight easily available variables had a moderate predictive value in predicting uterine rupture in women with scarred uterus. Strategies based on predictions may be considered to further reduce the burden of uterine rupture in China.
Topics: Cesarean Section; Cross-Sectional Studies; Female; Humans; Parity; Pregnancy; Pregnant Women; Retrospective Studies; Uterine Rupture
PubMed: 34845076
DOI: 10.1136/bmjopen-2021-054540 -
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 -
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 -
Ultrasound in Obstetrics & Gynecology :... Jan 2022To examine the performance of a model combining maternal risk factors, uterine artery pulsatility index (UtA-PI) and estimated fetal weight (EFW) at 19-24 weeks'...
Development and validation of model for prediction of placental dysfunction-related stillbirth from maternal factors, fetal weight and uterine artery Doppler at mid-gestation.
OBJECTIVE
To examine the performance of a model combining maternal risk factors, uterine artery pulsatility index (UtA-PI) and estimated fetal weight (EFW) at 19-24 weeks' gestation, for predicting all antepartum stillbirths and those due to impaired placentation, in a training dataset used for development of the model and in a validation dataset.
METHODS
The data for this study were derived from prospective screening for adverse obstetric outcome in women with singleton pregnancy attending for routine pregnancy care at 19 + 0 to 24 + 6 weeks' gestation. The study population was divided into a training dataset used to develop prediction models for placental dysfunction-related antepartum stillbirth and a validation dataset to which the models were then applied. Multivariable logistic regression analysis was used to develop a model based on a combination of maternal risk factors, EFW Z-score and UtA-PI multiples of the normal median. We examined the predictive performance of the model by, first, the ability of the model to discriminate between the stillbirth and live-birth groups, using the area under the receiver-operating-characteristics curve (AUC) and the detection rate (DR) at a fixed false-positive rate (FPR) of 10%, and, second, calibration by measurements of calibration slope and intercept.
RESULTS
The study population of 131 514 pregnancies included 131 037 live births and 477 (0.36%) stillbirths. There are four main findings of this study. First, 92.5% (441/477) of stillbirths were antepartum and 7.5% (36/477) were intrapartum, and 59.2% (261/441) of antepartum stillbirths were observed in association with placental dysfunction and 40.8% (180/441) were unexplained or due to other causes. Second, placental dysfunction accounted for 80.1% (161/201) of antepartum stillbirths at < 32 weeks' gestation, 54.2% (52/96) at 32 + 0 to 36 + 6 weeks and 33.3% (48/144) at ≥ 37 weeks. Third, the risk of placental dysfunction-related antepartum stillbirth increased with increasing maternal weight and decreasing maternal height, was 3-fold higher in black than in white women, was 5.5-fold higher in parous women with previous stillbirth than in those with previous live birth, and was increased in smokers, in women with chronic hypertension and in parous women with a previous pregnancy complicated by pre-eclampsia and/or birth of a small-for-gestational-age baby. Fourth, in screening for placental dysfunction-related antepartum stillbirth by a combination of maternal risk factors, EFW and UtA-PI in the validation dataset, the DR at a 10% FPR was 62.3% (95% CI, 57.2-67.4%) and the AUC was 0.838 (95% CI, 0.799-0.878); these results were consistent with those in the dataset used for developing the algorithm and demonstrate high discrimination between affected and unaffected pregnancies. Similarly, the calibration slope was 1.029 and the intercept was -0.009, demonstrating good agreement between the predicted risk and observed incidence of placental dysfunction-related antepartum stillbirth. The performance of screening was better for placental dysfunction-related antepartum stillbirth at < 37 weeks' gestation compared to at term (DR at a 10% FPR, 69.8% vs 29.2%).
CONCLUSIONS
Screening at mid-gestation by a combination of maternal risk factors, EFW and UtA-PI can predict a high proportion of placental dysfunction-related stillbirths and, in particular, those that occur preterm. Such screening provides poor prediction of unexplained stillbirth or stillbirth due to other causes. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
Topics: Adult; Female; Fetal Weight; Gestational Age; Humans; Placenta; Placenta Diseases; Placentation; Predictive Value of Tests; Pregnancy; Pregnancy Trimester, Second; Prenatal Diagnosis; Prospective Studies; Pulsatile Flow; Risk Assessment; Stillbirth; Ultrasonography, Doppler; Ultrasonography, Prenatal; Uterine Artery
PubMed: 34643306
DOI: 10.1002/uog.24795 -
BMC Women's Health Sep 2021Abortion and stillbirths are the common obstetrics condition in Ethiopia and their effect on the next pregnancy was not well identified in resource limited settings. The...
BACKGROUND
Abortion and stillbirths are the common obstetrics condition in Ethiopia and their effect on the next pregnancy was not well identified in resource limited settings. The aim of the study was to assess the effect of stillbirth and abortion on the next pregnancy.
METHODS
A prospective cohort study design was implemented. The study was conducted in Mecha demographic surveillance and field research center catchment areas. The data were collected from January 2015 to March 2019. Epi-info software was used to calculate the sample size. The systematic random sampling technique was used to select stillbirth and abortion women. Poison regression was used to identify the predictors of MCH service utilization; descriptive statistics were used to identify the prevalence of blood borne pathogens. The Kaplan Meier survival curve was used to estimate survival to pregnancy and pregnancy related medical disorders.
RESULTS
1091 stillbirth and 3,026 abortion women were followed. Hepatitis B was present in 6% of abortion and 3.2% of stillbirth women. Hepatitis C was diagnosed in 4.7% of abortion and 0.3% of stillbirth women. HIV was detected in 3% of abortion and 0.8% of stillbirth women. MCH service utilization was determined by knowledge of contraceptives [IRR 1.29, 95% CI 1.18-1.42], tertiary education [IRR 4.29, 95% CI 3.72-4.96], secondary education. [IRR 3.14, 95% CI 2.73-3.61], married women [IRR 2.08, 95% CI 1.84-2.34], family size [IRR 0.67, 95% CI 1.001-1.01], the median time of pregnancy after stillbirth and abortion were 12 months. Ante-partum hemorrhage was observed in 23.1% of pregnant mothers with a past history of abortion cases and post-partum hemorrhage was observed in 25.6% of pregnant mothers with a past history of abortion. PREGNANCY INDUCED DIABETES MELLITUS was observed 14.3% of pregnant mothers with a past history of stillbirth and pregnancy-induced hypertension were observed in 9.2% of mothers with a past history of stillbirth.
CONCLUSION
Obstetric hemorrhage was the common complications of abortion women while Pregnancy-induced diabetic Mellitus and pregnancy-induced hypertension were the most common complications of stillbirth for the next pregnancy.
Topics: Abortion, Induced; Abortion, Spontaneous; Female; Humans; Longitudinal Studies; Pregnancy; Prospective Studies; Stillbirth
PubMed: 34563190
DOI: 10.1186/s12905-021-01485-0 -
BMC Pregnancy and Childbirth Sep 2021Ethiopia is a Sub-Saharan country that has made significant improvements in maternal mortality and under-five mortality over the past 15 years. However, the nation...
BACKGROUND
Ethiopia is a Sub-Saharan country that has made significant improvements in maternal mortality and under-five mortality over the past 15 years. However, the nation continues to have one of the highest rates of perinatal mortality in the entire world with current estimates at 33 deaths per 1000 live births.
METHODS
This case-control study was conducted between October 2016 and May 2017 at Tikur Anbessa Hospital and Gandhi Memorial Hospital. All women who had a stillbirth or early neonatal death (i.e. death within 7 days) during this period willing to participate were included as cases. A systematic random sample of women delivering at the hospital were approached for recruitment as controls to generate a 2:1 ratio of controls to cases. Data on risk factors were retrieved from medical records including delivery records, and treatment charts. Statistical differences in background and social characteristics of cases and controls were determined by t-test and chi-squared (or fisher's exact test) for quantitative and categorical variables respectively. Binary logistic regression analysis was completed to determine any associations between risk factors and stillbirth/early neonatal death.
RESULTS
During the study period, 366 women delivering at the hospitals were enrolled as cases and 711 women delivering at the hospitals were enrolled as controls. Records from both hospitals indicated that the estimated stillbirth and neonatal mortality rates were 30.7 per 1000. Neonatal causes (43.4%) were the most common, followed by antepartum (32.5%) and intrapartum (24.5%). Risk factors for stillbirths and early neonatal death were low maternal education (aOR 1.747, 95%CI 1.098-2.780), previous stillbirth (aOR 9.447, 95%CI 6.245-14.289), previous preterm birth (aOR 3.620, 95%CI 2.363-5.546), and previous child with congenital abnormality (aOR 2.190, 95% 1.228-3.905), and antepartum hemorrhage during pregnancy (aOR 3.273, 95% 1.523-7.031).
CONCLUSION
Antepartum hemorrhaging is the only risk factor in our study amenable for direct intervention. Efforts should be maximized to improve patient education and antenatal and obstetric services. Moreover, the most significant cause of mortality was asphyxia-related causes. It is imperative that obstetric capacity in rehabilitation services are strengthened and for further studies to investigate the high burden of asphyxia at these tertiary hospitals to better tailor interventions.
Topics: Adult; Case-Control Studies; Ethiopia; Female; Humans; Infant, Newborn; Male; Perinatal Death; Perinatal Mortality; Pregnancy; Risk Factors; Stillbirth; Tertiary Care Centers; Young Adult
PubMed: 34548064
DOI: 10.1186/s12884-021-04025-8 -
Best Practice & Research. Clinical... Nov 2021Worldwide, there has been a trend toward later motherhood. Concurrently, the incidence of subfertility has been on the rise, necessitating conception using assisted... (Review)
Review
Worldwide, there has been a trend toward later motherhood. Concurrently, the incidence of subfertility has been on the rise, necessitating conception using assisted reproductive technologies (ARTs). These pregnancies are considered high risk due to fetal complications such as antepartum stillbirth and growth restriction and maternal complications such as increase in maternal morbidity and mortality. Early induction of labor can help to mitigate these risks. However, this has to be balanced against the iatrogenic harms of earlier delivery to both the baby, including respiratory distress and NICU stay, and the mother who might experience longer labor and other complications such as uterine hyperstimulation. Induction of labor at 39 weeks is the optimal timing for preventing antepartum stillbirth and avoiding iatrogenic harm. Delivery by elective cesarean section is not advocated as its benefits in these patients are unclear compared with the short- and long-term complications of a major abdominal surgery.
Topics: Cesarean Section; Female; Gestational Age; Humans; Labor, Induced; Maternal Age; Pregnancy; Reproductive Techniques, Assisted
PubMed: 34538560
DOI: 10.1016/j.bpobgyn.2021.08.007 -
JAMA Network Open Sep 2021Rates of maternal sepsis are increasing, and prior studies of maternal sepsis have focused on immediate maternal morbidity and mortality associated with sepsis during...
IMPORTANCE
Rates of maternal sepsis are increasing, and prior studies of maternal sepsis have focused on immediate maternal morbidity and mortality associated with sepsis during delivery admission. There are no data on pregnancy outcomes among individuals who recover from their infections prior to delivery.
OBJECTIVE
To describe perinatal outcomes among patients with antepartum sepsis who did not deliver during their infection hospitalization.
DESIGN, SETTING, AND PARTICIPANTS
This retrospective cohort study was conducted using data from August 1, 2012, to August 1, 2018, at an academic referral center in San Francisco, California. Included patients were all individuals with nonanomalous, singleton pregnancies who delivered after 20 weeks' gestation during the study period. Data were analyzed from March 2020 through March 2021.
EXPOSURES
Antepartum admission for infection with clinical concern for sepsis and hospital discharge prior to delivery.
MAIN OUTCOMES AND MEASURES
The primary outcome was a composite of perinatal outcomes associated with placental dysfunction and consisted of 1 or more of the following: fetal growth restriction, oligohydramnios, hypertensive disease of pregnancy, cesarean delivery for fetal indication, child who is small for gestational age, or stillbirth.
RESULTS
Among 14 565 patients with nonanomalous singleton pregnancies (mean [SD] age at delivery, 33.1 [5.2] years), 59 individuals (0.4%) were in the sepsis group and 14 506 individuals (99.6%) were in the nonsepsis group; 8533 individuals (59.0%) were nulliparous. Patients with sepsis, compared with patients in the reference group, were younger (mean [SD] age at delivery, 30.6 [5.7] years vs 33.1 [5.2] years; P < .001), were more likely to have pregestational diabetes (5 individuals [8.5%] vs 233 individuals [1.6%]; P = .003), and had higher mean (SD) pregestational body mass index scores (26.1 [6.1] vs 24.4 [5.9]; P = .03). In the sepsis group, the most common infections were urinary tract infections (24 patients [40.7%]) and pulmonary infections (22 patients [37.3%]). Among patients with sepsis, 5 individuals (8.5%) were admitted to the intensive care unit, the mean (SD) gestational age at infection was 24.6 (9.0) weeks, and the median (interquartile range) time from infection to delivery was 82 (42-147) days. Antepartum sepsis was associated with higher odds of placental dysfunction (21 patients [35.6%] vs 3450 patients [23.8%]; odds ratio, 1.77; 95% CI, 1.04-3.02; P = .04). On multivariable logistic regression analysis, antepartum sepsis was an independent factor associated with placental dysfunction (adjusted odds ratio, 1.88; 95% CI, 1.10-3.23; P = .02) after adjusting for possible confounders.
CONCLUSIONS AND RELEVANCE
This study found that pregnancies complicated by antepartum sepsis were associated with higher odds of placental dysfunction. These findings suggest that increased antenatal surveillance should be considered for these patients.
Topics: Adult; California; Female; Humans; Infant, Newborn; Male; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Outcome; Prenatal Care; Stillbirth
PubMed: 34477848
DOI: 10.1001/jamanetworkopen.2021.24109 -
The Journal of Maternal-fetal &... Dec 2022Placental chronic deciduitis is a lesion consistent with the presence of plasma cells within the placental basal plate. It could be associated with adverse pregnancy...
INTRODUCTION
Placental chronic deciduitis is a lesion consistent with the presence of plasma cells within the placental basal plate. It could be associated with adverse pregnancy outcomes, including stillbirth.
METHODS
We retrospectively evaluated a cohort of 180 antepartum stillborn cases from singleton pregnancies, with the aim of investigating the clinical-histopathological relationship. Placental slides were reviewed following the standard protocol proposed by the "Amsterdam consensus statement".
RESULTS
We observed an association between chronic deciduitis and lesions consistent with maternal vascular malperfusion, delayed villous maturation, villitis of unknown etiology and maternal autoimmunity.
CONCLUSIONS
The observed clinical-histopathological associations suggest that an extensive maternal investigation could improve the comprehension of factors interfering with the placental development and the increasing risk of adverse pregnancy outcomes. HighlightsChronic deciduitis is associated with lesions consistent with maternal vascular malperfusionChronic deciduitis is associated with delayed villous maturationChronic deciduitis is associated with villitis of unknown etiologyChronic deciduitis is associated with maternal autoimmunity.
Topics: Pregnancy; Female; Humans; Placenta; Stillbirth; Retrospective Studies; Placenta Diseases; Chorioamnionitis
PubMed: 34470133
DOI: 10.1080/14767058.2021.1967317