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The Journal of Obstetrics and... May 2022The International Classification of Diseases for Perinatal Mortality (ICD-PM) is a system for recording causes of perinatal death. In this system, placental pathology is...
Classification of stillbirth by the International Classification of Diseases for Perinatal Mortality using a sequential approach: A 20-year retrospective study from Thailand.
AIM
The International Classification of Diseases for Perinatal Mortality (ICD-PM) is a system for recording causes of perinatal death. In this system, placental pathology is considered a "maternal condition" and this category does not cover the spectrum of placental pathology that can impact on perinatal death. The aim of the study was to apply a wider spectrum of placental pathology as a separate parameter for classifying death in the ICD-PM.
METHODS
All autopsy reports at a single institution over a 20-year period (2001-2020) were reviewed. Causes of stillbirth were analyzed in a sequential manner: step 1, clinical history and laboratory results; step 2, placenta; and step 3, autopsy; and classified at each step according to the ICD-PM.
RESULTS
The review identified 330 cases, including 126 antepartum and 204 intrapartum deaths. Step 1 identified a cause in 176 (86%) intrapartum deaths and 64 (51%) antepartum deaths. The addition of placental pathology (step 2) changed the cause of death in 12% of cases, with causes now identified in 190 (93%) intrapartum and 89 (71%) antepartum deaths. Adding step 3 did not identify any additional causes of death.
CONCLUSION
The accuracy of the ICD-PM classification is dependent on the data available. Placental pathology made a significant difference in assigning causes of death in our series, stressing the importance of placental examination. Determination of the cause of death based on clinical history and laboratory data alone may be inaccurate, and less useful for comparative studies and planning prenatal care.
Topics: Female; Humans; Pregnancy; Cause of Death; International Classification of Diseases; Perinatal Death; Perinatal Mortality; Placenta; Retrospective Studies; Stillbirth; Thailand; Infant, Newborn
PubMed: 35178832
DOI: 10.1111/jog.15189 -
The Australian & New Zealand Journal of... Aug 2022There is scant literature about antepartum stillbirth management but guidelines usually recommend reserving caesarean sections for exceptional circumstances. However,...
BACKGROUND
There is scant literature about antepartum stillbirth management but guidelines usually recommend reserving caesarean sections for exceptional circumstances. However, little is known about caesarean section rates following antepartum stillbirth in Australia.
AIMS
We aimed to describe the onset of labour, mode of birth, and use of analgesia and anaesthesia following antepartum stillbirth and to identify factors associated with caesarean section.
MATERIAL AND METHODS
In this retrospective cohort study, we used a population-based dataset of all singleton antepartum stillbirths ≥20 weeks gestation in Western Australia between 2010-2015. The overall, primary and repeat caesarean section rates for antepartum stillbirths were calculated and multivariable Poisson regression analyses were performed to identify associated factors, and to calculate relative risks (RRs) and 95% confidence intervals (CIs).
RESULTS
This study included 634 antepartum stillbirths. Labour was spontaneous for 134 (21.1%), induced for 457 (72.1%), and 43 (6.8%) had a prelabour caesarean section. The overall, primary and repeat caesarean section rates were 8.5%, 4.6% and 23.0% respectively and increased with gestation (P trends all <0.01). Other factors associated with an increased caesarean section risk included: any placenta praevia or placental abruption, birth at a metropolitan private hospital, large-for-gestational-age birthweight, and any maternal chronic condition. During labour, the most frequently used types of analgesia were systemic narcotics (46.0%) and regional blocks (34.7%) while among those who had a caesarean section, 40.7% had a general anaesthetic.
CONCLUSIONS
In Western Australia between 2010-2015, the caesarean section rates among women with antepartum stillbirths were low, in line with current guidelines.
Topics: Cesarean Section; Female; Humans; Placenta; Pregnancy; Retrospective Studies; Stillbirth; Western Australia
PubMed: 35170023
DOI: 10.1111/ajo.13494 -
PloS One 2022To assess the risk of singleton intrauterine fetal death (IUFD) in women by the demographic setting of the online Fetal Medicine Foundation (FMF) Stillbirth Risk...
OBJECTIVE
To assess the risk of singleton intrauterine fetal death (IUFD) in women by the demographic setting of the online Fetal Medicine Foundation (FMF) Stillbirth Risk Calculator.
METHODS
Retrospective single-centre case-control study involving 144 women having suffered IUFD and 247 women after delivery of a live-born singleton. Nonparametric receiver operating characteristics (ROC) analyses were performed to predict the prognostic power of the FMF Stillbirth risk score and to generate a cut-off value to discriminate best between the event of IUFD versus live birth.
RESULTS
Women in the IUFD cohort born a significantly higher overall risk with a median FMF risk score of 0.45% (IQR 0.23-0.99) compared to controls [0.23% (IQR 0.21-0.29); p<0.001]. Demographic factors contributing to an increased risk of IUFD in our cohort were maternal obesity (p = 0.002), smoking (p<0.001), chronic hypertension (p = 0.015), antiphospholipid syndrome (p = 0.017), type 2 diabetes (p<0.001), and insulin requirement (p<0.001). ROC analyses showed an area under the curve (AUC) of 0.72 (95% CI 0.67-0.78; p<0.001) for predicting overall IUFD and an AUC of 0.72 (95% CI 0.64-0.80; p<0.001), respectively, for predicting IUFD excluding congenital malformations. The FMF risk score at a cut-off of 0.34% (OR 6.22; 95% CI 3.91-9.89; p<0.001) yielded an 82% specificity and 58% sensitivity in predicting IUFD with a positive and negative predictive value of 0.94% and 99.84%, respectively.
CONCLUSION
The FMF Stillbirth Risk Calculator based upon maternal demographic and obstetric characteristics only may help identify women at low risk of antepartum stillbirth.
Topics: Perinatology
PubMed: 35051188
DOI: 10.1371/journal.pone.0260964 -
Cadernos de Saude Publica 2022Perinatal mortality includes fetal mortality and early neonatal mortality (0 to 6 days of life). The study described perinatal deaths in Brazil in 2018 according to the...
Perinatal mortality includes fetal mortality and early neonatal mortality (0 to 6 days of life). The study described perinatal deaths in Brazil in 2018 according to the modified Wigglesworth classification. The data sources were the Brazilian Mortality Information System and the Brazilian Information System on Live Births. Fetal mortality and perinatal mortality rates were calculated per 1,000 total births (live births plus stillbirths) and the early neonatal mortality rate per 1,000 live births, compared using their respective 95% confidence intervals (95%CI). Perinatal deaths were classified in groups of antepartum causes, congenital anomalies, prematurity, asphyxia, and specific causes. For each group of causes, the study calculated the number of deaths by weight group, in addition to mortality rates and respective 95%CI, besides the spatial distribution of mortality rates by state of Brazil. A total of 35,857 infant deaths were recorded, of which 18,866 (52.6%) were early neonatal deaths, while stillbirths totaled 27,009. Perinatal deaths totaled 45,875, for a mortality rate of 15.5‰ births. The highest mortality rate (7.6‰; 7.5‰-7.7‰) was observed in the antepartum group, followed by prematurity (3.6‰; 3.6‰-3.7‰). In the antepartum group, 14 of the 27 states (eight of which in the Northeast and four in the North) presented perinatal mortality rates above the national rate. Perinatal mortality in Brazil was high, and most deaths could have been prevented with investment in prenatal and childbirth care.
Topics: Brazil; Female; Humans; Infant; Infant Mortality; Infant, Low Birth Weight; Infant, Newborn; Perinatal Death; Perinatal Mortality; Pregnancy
PubMed: 35043879
DOI: 10.1590/0102-311X00003121 -
American Journal of Obstetrics &... Mar 2022As a vulnerable population, pregnant women with a substance-related diagnosis (ie, substance use, misuse, or dependence) may use healthcare disproportionately.
BACKGROUND
As a vulnerable population, pregnant women with a substance-related diagnosis (ie, substance use, misuse, or dependence) may use healthcare disproportionately.
OBJECTIVE
The primary goal of this study was to evaluate the differences in the use of outpatient clinical visits, emergency department visits, and inpatient days in the hospital among women with and without a substance-related diagnosis during the antepartum period.
STUDY DESIGN
This retrospective study retrieved electronic health record data on women (age, 18-44 years) who delivered a single live birth or stillbirth at ≥20 weeks of gestation from April 1, 2012, to September 30, 2019. Imbalance in measured maternal sociodemographic and obstetrical characteristics between women with and without a substance-related diagnosis was attenuated using propensity score matching on key demographic characteristics (eg, age), yielding a matched 1:1 sample. Unadjusted and adjusted logistic regressions models were used to determine the association between a substance-related diagnosis and outpatient visits, emergency visits, and inpatient days.
RESULTS
From the total sample (n=16,770), the matched cohort consisted of 1986 deliveries. Of these, most were White (51.0%), or mixed or of some other race (31.1%). The mean age was 29.8 (standard deviation, 5.6). A substance-related diagnosis was identified in 993 women (50%) because of matching. Women with a substance-related diagnosis were more likely to have ≤10 outpatient visits than women without a substance-related diagnosis (adjusted odds ratio, 1.81 [95% confidence interval, 1.44-2.28]; P<.0001). Alcohol-, opioid-, and stimulant-related diagnoses were independently associated with ≤10 outpatient visits (adjusted odds ratio, 3.16 [95% confidence interval, 1.67-6.04]; P=.0005; adjusted odds ratio, 3.02 [95% confidence interval, 1.79-5.09]; P<.0001; adjusted odds ratio, 2.18 [95% confidence interval, 1.39-3.41]; P=.0007, respectively). Women with a substance-related diagnosis were more likely to have ≥1 emergency visit than women without a substance-related diagnosis (adjusted odds ratio, 1.36 [95% confidence interval, 1.00-1.85]; P<.0001). Opioid-, stimulant-, and nicotine-related diagnoses were independently associated with ≥1 emergency visit (adjusted odds ratio, 2.28 [95% confidence interval, 1.09-4.77]; P=.0287; adjusted odds ratio, 2.01 [95% confidence interval, 1.07-3.78]; P=.0301; adjusted odds ratio, 3.38 [95% confidence interval, 1.90-6.02]; P<.0001, respectively). Women with a substance-related diagnosis were more likely to have ≥3 inpatient days than women without a substance-related diagnosis (adjusted odds ratio, 1.69 [95% confidence interval, 1.07-2.67]; P=.0256). Opioid-, stimulant-, and nicotine-related diagnosis were independently associated with ≥3 inpatient days (adjusted odds ratio, 3.52 [95% confidence interval, 1.42-8.75]; P=.0067; adjusted odds ratio, 3.51 [95% confidence interval, 1.31-9.34]; P=.0123; adjusted odds ratio, 2.74 [95% confidence interval, 1.11-6.73]; P=.0285, respectively).
CONCLUSION
Women with a substance-related diagnosis during the antepartum period who delivered a single live birth or stillbirth at ≥20 weeks of gestation were experiencing fewer outpatient visits, more emergency department visits, and more inpatient days than women without a substance-related diagnosis. The type of substance-related diagnosis (eg, alcohol, opioids, stimulants, or nicotine) was associated with different patterns of healthcare use. The results from this study have reinforced the need to identify substance-related diagnoses in pregnant women early to minimize disproportionate healthcare service utilization through intervention and treatment.
Topics: Adolescent; Adult; Analgesics, Opioid; Female; Humans; Inpatients; Male; Nicotine; Outpatients; Pregnancy; Pregnant Women; Retrospective Studies; Stillbirth; Young Adult
PubMed: 34990875
DOI: 10.1016/j.ajogmf.2021.100559 -
The Journal of Infectious Diseases Mar 2022Although severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been associated with increased risk of adverse perinatal health outcomes, few...
BACKGROUND
Although severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been associated with increased risk of adverse perinatal health outcomes, few large-scale, community-based epidemiological studies have been conducted.
METHODS
We conducted a national cohort study using deidentified administrative claims data for 78 283 pregnancies with estimated conception before 30 April 2020 and pregnancy end after 11 March 2020. We identified SARS-CoV-2 infections using diagnostic and laboratory testing data, and compared the risk of pregnancy outcomes using Cox proportional hazard models treating coronavirus disease 2019 (COVID-19) as a time-varying exposure and adjusting for baseline covariates.
RESULTS
Of the pregnancies, 2655 (3.4%) had a documented SARS-CoV-2 infection. COVID-19 during pregnancy was not associated with risk of miscarriage, antepartum hemorrhage, or stillbirth, but was associated with 2-3 fold higher risk of induced abortion (adjusted hazard ratio [aHR], 2.60; 95% confidence interval [CI], 1.17-5.78), cesarean delivery (aHR, 1.99; 95% CI, 1.71-2.31), clinician-initiated preterm birth (aHR, 2.88; 95% CI, 1.93-4.30), spontaneous preterm birth (aHR, 1.79; 95% CI, 1.37-2.34), and fetal growth restriction (aHR, 2.04; 95% CI, 1.72-2.43).
CONCLUSIONS
Prenatal SARS-CoV-2 infection was associated with increased risk of adverse pregnancy outcomes. Prevention could have fetal health benefits.
Topics: Adult; COVID-19; Cohort Studies; Female; Humans; Infant, Newborn; Infectious Disease Transmission, Vertical; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Outcome; Premature Birth; SARS-CoV-2
PubMed: 34958090
DOI: 10.1093/infdis/jiab626 -
Journal of Clinical Medicine Dec 2021(1) Background: Across Europe, the incidence of antepartum stillbirth varies greatly, partly because of heterogeneous definitions regarding gestational weeks and...
(1) Background: Across Europe, the incidence of antepartum stillbirth varies greatly, partly because of heterogeneous definitions regarding gestational weeks and differences in legislation. With this study, we sought to provide a comprehensive overview on the demographics of antepartum stillbirth in Austria, defined as non-iatrogenic fetal demise ≥22 gestational weeks (/40). (2) Methods: We conducted a population-based study on epidemiological characteristics of singleton antepartum stillbirth in Austria between January 2008 and December 2020. Data were derived from the validated Austrian Birth Registry. (3) Results: From January 2008 through December 2020, the antepartum stillbirth rate ≥20/40 was 3.10, ≥22/40 3.14, and ≥24/40 2.83 per 1000 births in Austria. The highest incidence was recorded in the federal states of Vienna, Styria, and Lower and Upper Austria, contributing to 71.9% of all stillbirths in the country. In the last decade, significant fluctuations in incidence were noted: from 2011 to 2012, the rate significantly declined from 3.40 to 3.07‰, whilst it significantly increased from 2.76 to 3.49‰ between 2019 and 2020. The median gestational age of antepartum stillbirth in Austria was 33 (27-37) weeks. Stillbirth rates ≤26/40 ranged from 164.98 to 334.18‰, whilst the lowest rates of 0.58-8.4‰ were observed ≥36/40. The main demographic risk factors were maternal obesity and low parity. (4) Conclusions: In Austria, the antepartum stillbirth rate has remained relatively stable at 2.83-3.10 per 1000 births for the last decade, despite a significant decline in 2012 and an increase in 2020.
PubMed: 34945123
DOI: 10.3390/jcm10245828 -
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 -
Annals of Global Health 2021Smoking is one of the modifiable risk factors for adverse maternal and neonatal outcomes and is associated with low birth weight, preterm birth, respiratory, antepartum...
BACKGROUND
Smoking is one of the modifiable risk factors for adverse maternal and neonatal outcomes and is associated with low birth weight, preterm birth, respiratory, antepartum and intrapartum stillbirth, and perinatal death as well as long-term morbidity in offspring and sudden unexpected infant death. The rate of smoking in low- and middle-income countries is still relevantly high, and Jordan is no exception.
OBJECTIVE
To investigate the effect of active and passive smoking during pregnancy on adverse pregnancy outcomes.
METHODS
The case-control study was conducted in Jordan in June 2020. Healthy women with full-term singleton pregnancy (n = 180) were interviewed and stratified into three groups: Group I, active smokers; Group II, passive smokers; and Group III, nonsmokers. The study variables included demographic data, current pregnancy history, cotinine level of mothers and newborns, and perinatal outcomes. Statistical analysis was performed using the application package IBM SPSS 25. Various algorithms of statistical analysis were used depending on the type of distribution of feature and data quality. The threshold for statistical significance was set at < 0.05.
RESULTS
Active smokers had significantly lower gestational age at delivery compared to passive and nonsmoking women ( = 0.038 and = 0.003, respectively). Neonates from active smoking mothers had significantly lower birth weight compared to neonates from passive and nonsmoking women ( = 0.016 and = 0.019, respectively), significantly lower head and chest circumferences compared to babies from passive smokers ( < 0.001 and = 0.036, respectively), and significantly lower first-minute Apgar score compared to those from nonsmoking women ( = 0.023). The urine cotinine level was significantly higher in both active and passive smoking women (both < 0.01), and it was significantly higher in newborns who had been exposed to smoking in utero despite maternal active or passive smoking status (both < 0.001). There was a weak negative correlation between urine cotinine level and birth weight: = -0.14 for maternal cotinine level and = -0.15 for neonate cotinine level.
CONCLUSIONS
The current study illustrated that smoking during pregnancy leads to offspring with reduced birth weight, birth length, and head and chest circumference; reduces delivery gestational age; and lowers the first-minute Apgar score. Our study findings highlight the need for further research issued to smoking effects on perinatal outcomes, the implementation of actions to develop cessation interventions in the preconception period, and an evaluation of useful interventions to enhance a smoking-free environment during pregnancy.
Topics: Birth Weight; Case-Control Studies; Developing Countries; Female; Humans; Infant, Newborn; Maternal Exposure; Pregnancy; Premature Birth; Smoking; Tobacco Smoke Pollution
PubMed: 34900622
DOI: 10.5334/aogh.3384 -
Journal of Gynecology Obstetrics and... Feb 2022The present study is intended to investigate the causes of stillbirth and its relationship with maternal conditions using the International Classification of...
OBJECTIVE
The present study is intended to investigate the causes of stillbirth and its relationship with maternal conditions using the International Classification of Diseases-Perinatal Mortality (ICD-PM) system.
MATERIAL AND METHODS
All early and late fetal deaths between 2015 and 2020 were analyzed. Time of death, fetal causes, and the maternal conditions involved were identified using the ICD-PM classification system.
RESULTS
During the study period, out of 74,102 births a total of 475 stillbirths were recorded (6.4 per 1000 births), of which 83.6% of the cases were antepartum and 11.8% were intrapartum fetal deaths, and the time of death could not be determined in 4.6% of the cases. Fetal developmental disorder was the most common cause of antepartum fetal death (24.2%). Intrapartum deaths were mostly due to extremely low birth weight (44.6%). The most common maternal conditions involved were complications of placenta, cord, and membranes (19.8%).
CONCLUSION
The applicability of the ICD-PM classification system for stillbirths is easy. It was observed that fetal deaths mostly occurred in the antepartum period and the cause of death could not be identified in over half of these antepartum fetal deaths. In over half of the stillbirths, there is at least one maternal condition involved. The most common maternal conditions involved are complications of placenta, cord, and membranes. The most common maternal medical problem is hypertensive diseases of pregnancy.
Topics: Child, Preschool; Cross-Sectional Studies; Female; Fetal Diseases; Humans; Infant; Infant, Newborn; International Classification of Diseases; Male; Perinatal Death; Pregnancy; Risk Factors; Stillbirth; Turkey
PubMed: 34890860
DOI: 10.1016/j.jogoh.2021.102285