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Reproductive Health Nov 2020Stillbirth rates are high and represent a substantial proportion of the under-5 mortality in low and middle-income countries (LMIC). In LMIC, where nearly 98% of...
BACKGROUND
Stillbirth rates are high and represent a substantial proportion of the under-5 mortality in low and middle-income countries (LMIC). In LMIC, where nearly 98% of stillbirths worldwide occur, few population-based studies have documented cause of stillbirths or the trends in rate of stillbirth over time.
METHODS
We undertook a prospective, population-based multi-country research study of all pregnant women in defined geographic areas across 7 sites in low-resource settings (Kenya, Zambia, Democratic Republic of Congo, India, Pakistan, and Guatemala). Staff collected demographic and health care characteristics with outcomes obtained at delivery. Cause of stillbirth was assigned by algorithm.
RESULTS
From 2010 through 2018, 573,148 women were enrolled with delivery data obtained. Of the 552,547 births that reached 500 g or 20 weeks gestation, 15,604 were stillbirths; a rate of 28.2 stillbirths per 1000 births. The stillbirth rates were 19.3 in the Guatemala site, 23.8 in the African sites, and 33.3 in the Asian sites. Specifically, stillbirth rates were highest in the Pakistan site, which also documented a substantial decrease in stillbirth rates over the study period, from 56.0 per 1000 (95% CI 51.0, 61.0) in 2010 to 44.4 per 1000 (95% CI 39.1, 49.7) in 2018. The Nagpur, India site also documented a substantial decrease in stillbirths from 32.5 (95% CI 29.0, 36.1) to 16.9 (95% CI 13.9, 19.9) per 1000 in 2018; however, other sites had only small declines in stillbirth over the same period. Women who were less educated and older as well as those with less access to antenatal care and with vaginal assisted delivery were at increased risk of stillbirth. The major fetal causes of stillbirth were birth asphyxia (44.0% of stillbirths) and infectious causes (22.2%). The maternal conditions that were observed among those with stillbirth were obstructed or prolonged labor, antepartum hemorrhage and maternal infections.
CONCLUSIONS
Over the study period, stillbirth rates have remained relatively high across all sites. With the exceptions of the Pakistan and Nagpur sites, Global Network sites did not observe substantial changes in their stillbirth rates. Women who were less educated and had less access to antenatal and obstetric care remained at the highest burden of stillbirth.
STUDY REGISTRATION
Clinicaltrials.gov (ID# NCT01073475).
Topics: Delivery, Obstetric; Developing Countries; Female; Guatemala; Humans; India; Infant, Newborn; Kenya; Male; Obstetric Labor Complications; Pakistan; Population Surveillance; Pregnancy; Prospective Studies; Stillbirth; Zambia
PubMed: 33256783
DOI: 10.1186/s12978-020-00991-y -
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 -
BMC Pregnancy and Childbirth Sep 2020Annually, 2.6 million stillbirths occur around the world, with approximately 98% occurring in low- and middle-income countries. The stillbirth rates in these countries...
BACKGROUND
Annually, 2.6 million stillbirths occur around the world, with approximately 98% occurring in low- and middle-income countries. The stillbirth rates in these countries are 10 times higher than the rates in high-income countries.
METHODS
An electronic stillbirths and neonatal deaths surveillance system (JSANDS) was established in five large hospitals located in three of the largest cities in Jordan in August 2019. JSANDS was developed as a secure on-line data entry system to collect, organize, analyze, and disseminate data on stillbirths, neonatal deaths, and their contributing conditions. Data on births, stillbirths and their contributing conditions, and other demographic and clinical characteristics in the period between August 2019 - January 2020 were extracted and analyzed.
RESULTS
A total of 10,328 births were registered during the reporting period. Of the total births, 102 were born dead (88 antepartum stillbirths and 14 intrapartum stillbirths), with a rate of 9.9 per 1000 total births. The main contributing fetal conditions of antepartum stillbirths were antepartum death of unspecified cause (33.7%), acute antepartum event (hypoxia) (33.7%), congenital malformations and chromosomal abnormalities (13.3%), and disorders related to the length of gestation and fetal growth (10.8%). The main contributing maternal conditions of antepartum stillbirths included complications of the placental cord and membranes (48.7%), maternal complications of pregnancy (23.1%), and maternal medical and surgical conditions (23.1%). Contributing fetal conditions of intrapartum stillbirths included congenital malformations, deformations and chromosomal abnormalities, other specified intrapartum disorders, and intrapartum death of unspecified cause (33.3% each). Contributing maternal conditions of intrapartum stillbirths included complications of the placental cord and membranes. In the multivariate analysis, small for gestational age (SGA) pregnancies were associated with a significant 3-fold increased risk of stillbirth compared to appropriate for gestational age (AGA) pregnancies.
CONCLUSIONS
Although the rate of stillbirth is lower than that in other countries in the region, there is an opportunity to prevent such deaths. While the majority of stillbirths occurred during the antepartum period, care should be taken for the early identification of high-risk pregnancies, including the early detection of SGA pregnancies, and ensuring adequate antenatal obstetric interventions.
Topics: Adolescent; Adult; Cause of Death; Female; Fetal Diseases; Humans; Infant, Newborn; Jordan; Male; Perinatal Death; Population Surveillance; Pregnancy; Pregnancy Complications; Stillbirth; Young Adult
PubMed: 32993562
DOI: 10.1186/s12884-020-03267-2 -
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 -
Global Health Action Dec 2020Suriname has one of the highest stillbirth rates in Latin America and the Caribbean. To facilitate data comparison of perinatal deaths, the World Health Organization...
BACKGROUND
Suriname has one of the highest stillbirth rates in Latin America and the Caribbean. To facilitate data comparison of perinatal deaths, the World Health Organization developed the International Classification of Diseases-10 Perinatal Mortality (ICD-PM).
OBJECTIVE
We aimed to (1) assess characteristics and risk indicators of women with a stillbirth, (2) determine the timing and causes of stillbirths according to the ICD-PM with critical evaluation of its application and (3) propose recommendations for the reduction of stillbirths in Suriname.
METHODS
A hospital-based, nation-wide, cross-sectional study was conducted in all hospitals within Suriname during one-year (2017). The medical files of stillbirths (gestation ≥28 weeks/birth weight ≥1000 grams) were reviewed and classified using ICD-PM. We used descriptive statistics and multiple logistic regression analyses.
RESULTS
The stillbirth rate in Suriname was 14.4/1000 births (n=131 stillbirths, n=9089 total births). Medical files were available for 86% (n=113/131) of stillbirths. Women of African descent had the highest stillbirth rate and two times the odds of stillbirth (OR 2.1, 95%CI 1.4-3.1) compared to women of other ethnicities. One third (33%, n=37/113) of stillbirths occurred after hospital admission. The timing was antepartum in 85% (n=96/113), intrapartum in 11% (n=12/113) and unknown in 4% (n=5/113). Antepartum stillbirths were caused by in 46% (n=44/96). In 41% (n=39/96) the cause was unspecified. were present in 50% (n=57/113), mostly hypertensive disorders.
CONCLUSION
Stillbirth reduction strategies in Suriname call for targeting ethnic disparities, improving antenatal services, implementing perinatal death audits and improving diagnostic post-mortem investigations. ICD-PM limited the formulation of recommendations due to many stillbirths of 'unspecified' causes. Based on our study findings, we also recommend addressing some challenges with applying the ICD-PM.
ABBREVIATIONS
CTG: Cardiotocography; ENAP: Every Newborn Action Plan (ENAP); ICD-PM: The WHO application of ICD-10 to deaths during the perinatal period - perinatal mortality; SBR: Stillbirth rate; SGA: Small for gestational age; WHO: World Health Organization; LMIC: Low- and middle-income countries; FHR: foetal heart rate.
Topics: Adult; Caribbean Region; Cause of Death; Cross-Sectional Studies; Female; Hospitals; Humans; Infant, Newborn; International Classification of Diseases; Parturition; Perinatal Death; Perinatal Mortality; Pregnancy; Risk Factors; Stillbirth; Suriname; World Health Organization
PubMed: 32777997
DOI: 10.1080/16549716.2020.1794105 -
BJOG : An International Journal of... Jan 2021To estimate a stillbirth rate at 24 or more gestational weeks in 2015-2016 and to explore potentially preventable causes in China.
OBJECTIVE
To estimate a stillbirth rate at 24 or more gestational weeks in 2015-2016 and to explore potentially preventable causes in China.
DESIGN
A multi-centre cross-sectional study.
SETTING
Ninety-six hospitals distributed in 24 (of 34) provinces in China.
POPULATION
A total of 75 132 births at 24 completed weeks of gestation or more.
METHODS
COX Proportional Hazard Models were performed to examine risk factors for antepartum and intrapartum stillbirths. Population attributable risk percentage was calculated for major risk factors. Correspondence analysis was used to explore region-specific risk factors for stillbirths.
MAIN OUTCOME MEASURES
Stillbirth rate and risk factors for stillbirth.
RESULTS
A total of 75 132 births including 949 stillbirths were used for the final analysis, giving a weighted stillbirth rate of 13.2 per 1000 births (95% CI 7.9-18.5). Small for gestational age (SGA) and pre-eclampsia/eclampsia increased antepartum stillbirths by 26.2% and 11.7%, respectively. Fetal anomalies increased antepartum and intrapartum stillbirths by 17.9% and 7.4%, respectively. Overall, 31.4% of all stillbirths were potentially preventable. Advanced maternal age, pre-pregnant obesity, chronic hypertension and diabetes mellitus were important risk factors in East China; low education and SGA were major risk factors in Northwest, Southwest, Northeast and South China; and pre-eclampsia/eclampsia and intrapartum complications were significant risk factors in Central China.
CONCLUSIONS
The prevalence of stillbirth was 13.2 per 1000 births in China in 2015-2016. Nearly one-third of all stillbirths may be preventable. Strategies based on regional characteristics should be considered to reduce further the burden of stillbirths in China.
TWEETABLE ABSTRACT
The stillbirth rate was 13.2 per 1000 births in China in 2015-2016 and nearly one-third of all stillbirths may be preventable.
Topics: China; Cross-Sectional Studies; Female; Gestational Age; Humans; Infant, Newborn; Pregnancy; Prenatal Care; Risk Factors; Socioeconomic Factors; Stillbirth; Surveys and Questionnaires
PubMed: 32770714
DOI: 10.1111/1471-0528.16458 -
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 -
PloS One 2020Globally, the under-10 years of age mortality has not been comprehensively studied. We applied the life-course perspective in the analysis and interpretation of the...
Under 10 mortality patterns, risk factors, and mechanisms in low resource settings of Eastern Uganda: An analysis of event history demographic and verbal social autopsy data.
BACKGROUND
Globally, the under-10 years of age mortality has not been comprehensively studied. We applied the life-course perspective in the analysis and interpretation of the event history demographic and verbal autopsy data to examine when and why children die before their 10th birthday.
METHODS
We analysed a decade (2005-2015) of event histories data on 22385 and 1815 verbal autopsies data collected by Iganga-Mayuge HDSS in eastern Uganda. We used the lifetable for mortality estimates and patterns, and Royston-Parmar survival analysis approach for mortality risk factors' assessment.
RESULTS
The under-10 and 5-9 years of age mortality probabilities were 129 (95% Confidence Interval [CI] = 123-370) per 1000 live births and 11 (95% CI = 7-26) per 1000 children aged 5-9 years, respectively. The top four causes of new-born mortality and stillbirth were antepartum maternal complications (31%), intrapartum-related causes including birth injury, asphyxia and obstructed labour (25%), Low Birth Weight (LBW) and prematurity (20%), and other unidentified perinatal mortality causes (18%). Malaria, protein deficiency including anaemia, diarrhoea or gastrointestinal, and acute respiratory infections were the major causes of mortality among those aged 0-9 years-contributing 88%, 88% and 46% of all causes of mortality for the post-neonatal, child and 5-9 years of age respectively. 33% of all causes of mortality among those aged 5-9 years was a share of Injuries (22%) and gastrointestinal (11%). Regarding the deterministic pattern, nearly 30% of the new-borns and sick children died without access to formal care. Access to the treatment for the top five morbidities was after 4 days of symptoms' recognition. The childhood mortality risk factors were LBW, multiple births, having no partner, adolescence age, rural residence, low education level and belonging to a poor household, but their association was stronger among infants.
CONCLUSIONS
We have identified the vulnerable groups at risk of mortality as LBW children, multiple births, rural dwellers, those whose mother are of low socio-economic position, adolescents and unmarried. The differences in causes of mortalities between children aged 0-5 and 5-9 years were noted. These findings suggest for a strong life-course approach in the design and implementation of child health interventions that target pregnant women and children of all ages.
Topics: Adolescent; Adult; Cause of Death; Child; Child Health; Child Mortality; Child, Preschool; Female; Humans; Infant; Infant Health; Infant Mortality; Infant, Newborn; Male; Maternal Health; Maternal-Child Health Services; Medical History Taking; Socioeconomic Factors; Uganda
PubMed: 32525931
DOI: 10.1371/journal.pone.0234573 -
PloS One 2020Hypertensive disorders in pregnancy including pre-eclampsia are associated with maternal and newborn mortality and morbidity. Early detection is vital for effective...
BACKGROUND
Hypertensive disorders in pregnancy including pre-eclampsia are associated with maternal and newborn mortality and morbidity. Early detection is vital for effective treatment and management of pre-eclampsia. This study examines and compares the clinical presentation and outcomes between early- and late-onset pre-eclampsia over a two year period.
METHODS
A retrospective cohort study design which examines socio-demographic characteristics, treatment, outcomes, and fetal and maternal complications among women with early onset of pre-eclampsia (EO-PE) and late onset of pre-eclampsia (LO-PE). De-identified records of women who attended antenatal, intrapartum and postnatal care services and experienced pre-eclampsia at Kenyatta National teaching and referral hospital were reviewed. We used chi square, t-test, and calculated odds ratio to determine any significant differences between the EO-PE and LO-PE cohorts.
RESULTS
Out of 620 pre-eclamptic and eclamptic patients' records analyzed; 44 percent (n = 273) exhibited EO-PE, while 56 percent had late onset. Women with EO-PE compared to LO-PE had greater odds of adverse maternal and perinatal outcomes including hemolysis elevated liver enzymes and low platelets (HELLP) syndrome (OR: 4.3; CI 2.0-10.2; p<0.001), renal dysfunction (OR; 1.7; CI 0.7-4.1; p = 0.192), stillbirth (OR = 4.9; CI 3.1-8.1; p<0.001), and neonatal death (OR: 8.5; CI 3.8-21.3; p<0.001). EO-PE was also associated with higher odds of prolonged maternal hospitalization, beyond seven days (OR = 5.8; CI 3.9-8.4; p<0.001), and antepartum hemorrhage (OR = 5.8; CI 1.1-56.4; p<0.001). Neonates born after early onset of pre-eclampsia had increased odds of respiratory distress (OR = 17.0; CI 9.0-32.3, p<0.001) and birth asphyxia (OR: 1.9; CI 0.7-4.8; p = 0.142).
CONCLUSIONS
The profiles and outcomes of women with EO-PE (compared to late onset) suggest that seriousness of morbidity increases with earlier onset. To reduce adverse neonatal and maternal outcomes, it is critical to identify, manage, referral and closely follow-up pregnant women with pre-eclampsia throughout the pregnancy continuum.
ETHICAL APPROVAL
This study protocol was approved by Population Council's research ethics Institutional Review Board, Protocol 813, and KNH-UoN Ethics and Research Committee, Protocol 293/06/2017.
Topics: Adult; Cohort Studies; Eclampsia; Female; Gestational Age; Humans; Hypertension; Infant, Newborn; Kenya; Middle Aged; Perinatal Death; Pre-Eclampsia; Pregnancy; Pregnancy Outcome; Prenatal Care; Retrospective Studies; Young Adult
PubMed: 32502144
DOI: 10.1371/journal.pone.0233323 -
Cureus Apr 2020Lethal congenital malformations (LCMs) are fatal birth defects that are an important cause of fetal/neonatal death. There is a lack of informative data about these...
Lethal congenital malformations (LCMs) are fatal birth defects that are an important cause of fetal/neonatal death. There is a lack of informative data about these malformations in India, a country that shares the maximum burden of neonatal mortality due to congenital birth defects. Therefore, we conducted a retrospective analysis to know the prevalence of LCMs in late pregnancy, to find out associated factor/variables and to evaluate fetal/neonatal outcome of such anomalies; at a tertiary-care referral centre in North India. All deliveries with LCMs after 24 weeks of gestation were included in the study. Data about antepartum history (maternal age, parity, education, socioeconomic status, consanguineous marriage, folic acid intake, any chronic medical disorder, availability of anomaly scan, unplanned pregnancy); intrapartum events (gestational age at delivery, mode of delivery); postpartum events (weight of the baby, gender of the baby); newborn evaluation; and details of hospital stay were recorded from medical record sheet over the duration of one year. We found that anencephaly, severe meningomyelocele, multicystic dysplastic kidneys and non-immune hydrops with major cardiac defects were more prevalent among all LCMs. On the evaluation of the various studied variables, maximum babies with LCMs were born to mothers who were between 20 and 35 years of age, those who were illiterate, belonged to middle/lower socio-economic class, multigravida, and those who had no detailed anomaly scan. We feel that there is an urgent need to formulate a universally accepted definition of LCMs, to identify preventable risk factors and to formulate management strategy for both mother and liveborn baby with LCMs, in order to minimize the hidden burden of these defects in stillbirth/ perinatal/ neonatal mortality statistics.
PubMed: 32373406
DOI: 10.7759/cureus.7502