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Iranian Journal of Public Health Apr 2017We aimed to explore whether maternal asymptomatic hepatitis B (HB) infection effects on pre-term rupture of membranous (PROM), stillbirth, preeclampsia, eclampsia,... (Review)
Review
BACKGROUND
We aimed to explore whether maternal asymptomatic hepatitis B (HB) infection effects on pre-term rupture of membranous (PROM), stillbirth, preeclampsia, eclampsia, gestational hypertension, or antepartum hemorrhage.
METHODS
We searched the PubMed, Scopus, and ISI web of science from 1990 to Feb 2015. In addition, electronic literature searches supplemented by searching the gray literature (e.g., conference abstracts thesis and the result of technical reports) and scanning the reference lists of included studies and relevant systematic reviews. We explored statistical heterogeneity using the, I2 and tau-squared (Tau2) statistical tests.
RESULTS
Eighteen studies were included. Preterm rupture of membranous (PROM), stillbirth, preeclampsia, eclampsia, gestational hypertension and antepartum hemorrhage were considerable outcomes in this survey. The results showed no significant association between inactive HB and these complications in pregnancy. The small amounts of -value and chi-square and large amount of I2 suggested the probable heterogeneity in this part, which we tried to modify with statistical methods such as subgroup analysis.
CONCLUSION
Inactive HB infection did not increase the risk of adversely mentioned outcomes in this study. Further, well-designed studies should be performed to confirm the results.
PubMed: 28540262
DOI: No ID Found -
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 -
Acta Obstetricia Et Gynecologica... Dec 2017Antepartum stillbirth is often preceded by detectable signs of fetal compromise, including changes in fetal heart rate and movement. It is hypothesized that continuous... (Review)
Review
INTRODUCTION
Antepartum stillbirth is often preceded by detectable signs of fetal compromise, including changes in fetal heart rate and movement. It is hypothesized that continuous fetal monitoring could detect these signs more accurately and objectively than current forms of fetal monitoring and allow for timely intervention. This systematic review aimed to explore available evidence on women's experiences of continuous fetal monitoring to investigate its acceptability before clinical implementation and to inform clinical studies.
MATERIAL AND METHODS
Systematic searching of four electronic databases (Embase, PsycINFO, MEDLINE and CINAHL), using key terms defined by initial scoping searches, identified a total of 35 studies. Following title and abstract screening by two independent researchers, five studies met the inclusion criteria. Studies were not excluded based on language, methodology or quality assessment. An integrative methodology was used to synthesize qualitative and quantitative data together.
RESULTS
Forms of continuous fetal monitoring used included Monica AN24 monitors (n = 4) and phonocardiography (n = 1). Four main themes were identified: practical limitations of the device, negative emotions, positive perceptions, and device implementation. Continuous fetal monitoring was reported to have high levels of participant satisfaction and was preferred by women to intermittent cardiotocography.
CONCLUSION
This review suggests that continuous fetal monitoring is accepted by women. However, it has also highlighted both the paucity and heterogeneity of current studies and suggests that further research should be conducted into women's experiences of continuous fetal monitoring before such devices can be used clinically.
Topics: Female; Fetal Monitoring; Humans; Patient Acceptance of Health Care; Pregnancy
PubMed: 28902389
DOI: 10.1111/aogs.13231 -
BMJ Open Aug 2023In high mortality settings, prophylactic azithromycin has been shown to improve birth weight and gestational age at birth when administered antenatally, to reduce the...
INTRODUCTION
In high mortality settings, prophylactic azithromycin has been shown to improve birth weight and gestational age at birth when administered antenatally, to reduce the incidence of neonatal infections when administered intrapartum, and to improve survival when administered in infancy. Questions remain regarding whether azithromycin can prevent stillbirths, and regarding the optimal strategy for the delivery of azithromycin to pregnant women and their infants.
METHODS AND ANALYSIS
Sauver avec l'Azithromycine en Traitant les Femmes Enceintes et les Enfants (SANTE) is a 2×2 factorial, individually randomised, placebo-controlled, double-masked trial in rural Mali. The primary aims are: (1A) to assess the efficacy of antenatal and intrapartum azithromycin on a composite outcome of stillbirths and infant mortality through 6-12 months and (1B) to assess the efficacy of azithromycin administered concurrently with the first and third doses of pentavalent vaccines (Penta-1/3) on infant mortality through 6-12 months. Pregnant participants (n=49 600) and their infants are randomised 1:1:1:1 to one of four treatment arms: (1) mother and infant receive azithromycin, (2) mother and infant receive placebo, (3) mother receives azithromycin and infant receives placebo or (4) mother receives placebo and infant receives azithromycin. Pregnant participants receive three single 2 g doses: two antepartum and one intrapartum. Infants receive a single 20 mg/kg dose at the Penta-1 and 3 visits. An additional cohort of 12 000 infants is recruited at the Penta-1 visit and randomised 1:1 to receive azithromycin or placebo at the same time points. The SANTE trial will inform guidelines and policies regarding the administration of antenatal and infant azithromycin using routine healthcare delivery platforms.
ETHICS AND DISSEMINATION
This trial was approved by the Institutional Review Board at the University of Maryland School of Medicine (Protocol #HP-00084242) and the Faculté de Médecine et d'Odonto-Stomatologie in Mali. The findings of this trial will be published in open access peer-reviewed journals.
TRIAL REGISTRATION NUMBER
NCT03909737.
Topics: Pregnancy; Infant, Newborn; Female; Infant; Humans; Stillbirth; Azithromycin; Mali; Parturition; Infant Death; Randomized Controlled Trials as Topic
PubMed: 37648393
DOI: 10.1136/bmjopen-2022-067581 -
Human Reproduction (Oxford, England) Oct 2018How is endometriosis associated with adverse maternal, fetal and neonatal outcomes of pregnancy? (Meta-Analysis)
Meta-Analysis
STUDY QUESTION
How is endometriosis associated with adverse maternal, fetal and neonatal outcomes of pregnancy?
SUMMARY ANSWER
Women with endometriosis are at elevated risk for serious and important adverse maternal (pre-eclampsia, gestational diabetes, placenta praevia and Cesarean section) and fetal or neonatal outcomes (preterm birth, PPROM, small for gestational age, stillbirth and neonatal death).
WHAT IS KNOWN ALREADY
A number of studies have shown an association between endometriosis and certain adverse maternal and fetal outcomes, but the results have been conflicting with potential for confounding by the use of assisted reproductive technology.
STUDY DESIGN, SIZE, DURATION
A systematic review and meta-analysis of observational studies (1 January 1990-31 December 2017) that evaluated the effect of endometriosis on maternal, fetal and neonatal outcomes was conducted.
PARTICIPANTS/MATERIALS, SETTING, METHODS
Studies were considered for inclusion if they were prospective or retrospective cohort or case-control studies; included women greater than 20 weeks gestational age with endometriosis; included a control group of gravid women without endometriosis; and, reported at least one of the outcomes of interest. Each study was reviewed for inclusion, data were extracted and risk of bias was assessed by two independent reviewers.
MAIN RESULTS AND THE ROLE OF CHANCE
The search strategy identified 33 studies (sample size, n = 3 280 488) for inclusion. Compared with women without endometriosis, women with endometriosis had higher odds of pre-eclampsia (odds ratio [OR] = 1.18 [1.01-1.39]), gestational hypertension and/or pre-eclampsia (OR = 1.21 [1.05-1.39]), gestational diabetes (OR = 1.26 [1.03-1.55]), gestational cholestasis (OR = 4.87 [1.85-12.83]), placenta praevia (OR = 3.31 [2.37, 4.63]), antepartum hemorrhage (OR = 1.69 [1.38-2.07]), antepartum hospital admissions (OR = 3.18 [2.60-3.87]), malpresentation (OR = 1.71 [1.34, 2.18]), labor dystocia (OR = 1.45 [1.04-2.01]) and cesarean section (OR = 1.86 [1.51-2.29]). Fetuses and neonates of women with endometriosis were also more likely to have preterm premature rupture of membranes (OR = 2.33 [1.39-3.90]), preterm birth (OR = 1.70 [1.40-2.06]), small for gestational age <10th% (OR = 1.28 [1.11-1.49]), NICU admission (OR = 1.39 [1.08-1.78]), stillbirth (OR = 1.29 [1.10, 1.52]) and neonatal death (MOR = 1.78 [1.46-2.16]). Among the subgroup of women who conceived spontaneously, endometriosis was found to be associated with placenta praevia, cesarean section, preterm birth and low birth weight. Among the subgroup of women who conceived with the use of assisted reproductive technology, endometriosis was found to be associated with placenta praevia and preterm birth.
LIMITATIONS, REASONS FOR CAUTION
As with any systematic review, the review is limited by the quality of the included studies. The diagnosis for endometriosis and the selection of comparison groups were not uniform across studies. However, the effect of potential misclassification would be bias towards the null hypothesis.
WIDER IMPLICATIONS OF THE FINDINGS
The association between endometriosis with the important and serious pregnancy outcomes observed in our meta-analysis, in particular stillbirth and neonatal death, is concerning and warrants further studies to elucidate the mechanisms for the observed findings.
STUDY FUNDING/COMPETING INTEREST(S)
Dr Shifana Lalani is supported by a Physicians' Services Incorporated Foundation Research Grant, and Dr Innie Chen is supported by a University of Ottawa Clinical Research Chair in Reproductive Population Health and Health Services. Dr Singh declares conflicts of interests with Bayer, Abvie, Allergan and Cooper Surgical. All other authors have no conflicts of interests to declare.
REGISTRATION NUMBER
PROSPERO CRD42015013911.
Topics: Case-Control Studies; Cesarean Section; Diabetes, Gestational; Endometriosis; Female; Humans; Infant, Newborn; Perinatal Death; Placenta Previa; Postpartum Hemorrhage; Pre-Eclampsia; Pregnancy; Premature Birth; Prospective Studies; Retrospective Studies; Stillbirth
PubMed: 30239732
DOI: 10.1093/humrep/dey269 -
International Journal of Infectious... Feb 2024Chikungunya virus (CHIKV), a reemerging global public health concern, which causes acute febrile illness, rash, and arthralgia and may affect both mothers and infants...
OBJECTIVES
Chikungunya virus (CHIKV), a reemerging global public health concern, which causes acute febrile illness, rash, and arthralgia and may affect both mothers and infants during pregnancy. Mother-to-child transmission (MTCT) of CHIKV in Africa remains understudied.
METHODS
Our cohort study screened 1006 pregnant women with a Zika/dengue/CHIKV rapid test at two clinics in Nigeria between 2019 and 2022. Women who tested positive for the rapid test were followed through their pregnancy and their infants were observed for 6 months, with a subset tested by reverse transcription-polymerase chain reaction (RT-PCR) and neutralization, to investigate seropositivity rates and MTCT of CHIKV.
RESULTS
Of the 1006, 119 tested positive for CHIKV immunoglobulin (Ig)M, of which 36 underwent detailed laboratory tests. While none of the IgM reactive samples were RT-PCR positive, 14 symptomatic pregnant women were confirmed by CHIKV neutralization test. Twelve babies were followed with eight normal and four abnormal outcomes, including stillbirth, cleft lip/palate with microcephaly, preterm delivery, polydactyly with sepsis, and jaundice. CHIKV IgM testing identified three possible antepartum transmissions.
CONCLUSION
In Nigeria, we found significant CHIKV infection in pregnancy and possible CHIKV antepartum transmission associated with birth abnormalities.
Topics: Infant; Infant, Newborn; Humans; Female; Pregnancy; Chikungunya virus; Pregnant Women; Cohort Studies; Nigeria; Cleft Lip; Infectious Disease Transmission, Vertical; Cleft Palate; Chikungunya Fever; Zika Virus Infection; Zika Virus; Stillbirth; Immunoglobulin M; Dengue
PubMed: 38056689
DOI: 10.1016/j.ijid.2023.11.036 -
International Journal of Gynaecology... Aug 2021To evaluate the association between obstetric and medical risk factors and stillbirths in a Kenyan set-up.
OBJECTIVE
To evaluate the association between obstetric and medical risk factors and stillbirths in a Kenyan set-up.
METHODS
A case-control study was conducted in four hospitals between August 2018 and April 2019. Two hundred and fourteen women with stillbirths and 428 with live births at more than >28 weeks of gestation were enrolled. Data collection was via interviews and abstraction from medical records. Outcome variables were stillbirth and live birth; exposure variables were sociodemographic characteristics, and medical and obstetric factors. The two-sample t test and χ test were used to compare continuous and categorical variables respectively. The association between the exposure and outcome variable was done using logistic regression. A P value less than 0.05 was considered statistically significant.
RESULTS
Stillbirth was associated with pre-eclampsia without severe features (odds ratio [OR] 9.1, 95% confidence interval [CI] 2.6-32.5), pre-eclampsia with severe features (OR 7.4, 95% CI 2.4-22.8); eclampsia (OR 9.2, 95% CI 2.6-32.5), placenta previa (OR 8.6 95% CI 2.8-25.9), placental abruption (OR 6.9 95% CI 2.2-21.3), preterm delivery(OR 9.5, 95% CI 5.7-16), and gestational diabetes mellitus, (OR 11.5, 95% CI 2.5-52.6). Stillbirth was not associated with multiparity, anemia, and HIV.
CONCLUSION
Proper antepartum care and surveillance to identify and manage medical and obstetric conditions with the potential to cause stillbirth are recommended.
Topics: Adult; Case-Control Studies; Diabetes, Gestational; Female; Humans; Infant, Newborn; Kenya; Obstetric Labor Complications; Parity; Placenta; Poverty; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Premature Birth; Prenatal Care; Risk Factors; Stillbirth; Young Adult
PubMed: 33306840
DOI: 10.1002/ijgo.13528 -
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 -
Acta Obstetricia Et Gynecologica... 2007The objective of this study was to explore the relationship between intrapartum and antepartum stillbirths and various measures of obstetric care in developing and... (Comparative Study)
Comparative Study
BACKGROUND
The objective of this study was to explore the relationship between intrapartum and antepartum stillbirths and various measures of obstetric care in developing and developed countries.
METHODS
For 51 countries, we obtained data about intrapartum and antepartum stillbirth rates and obstetric care measures from the World Health Organisation (WHO) and other sources. Using piecewise regression techniques, the relationships between the intrapartum and antepartum stillbirth rates and the various measures of obstetric care were determined.
RESULTS
Developed countries had lower total stillbirth rates (6.0 versus 21.3/1,000 births, p=0.0002) as well as a lower fraction of stillbirths that were intrapartum (0.16 versus 0.31, p=0.0019). Developed country antepartum stillbirth rates were 5.2 versus 14.0/1,000 in developing countries (p=0.0002). The highest antepartum stillbirth rates, all in southern Africa and Asia, ranged from 25 to 35/1,000 births. Intrapartum stillbirth rates averaged 0.9/1,000 births for developed countries compared to 7.3/1,000 in developing countries (p=0.0024), but ranged as high as 20-25/1,000 births for some countries in southern Africa and Asia. The relationship between intrapartum stillbirth and the various measures of care were generally stronger than those for antepartum stillbirth. Over the entire range of values, for each 1% increase in the percentage of women with at least 4 antenatal visits, the intrapartum stillbirth rate decreased by 0.16 per 1,000 births (p<0.0001). As cesarean section rates increased from 0 to 8%, for each 1% increase, there was a decrease of 1.61 intrapartum stillbirths per 1,000 births. There was no relationship between the cesarean section rates and intrapartum stillbirth rates in developed countries.
CONCLUSIONS
The intrapartum stillbirth rate is more closely related to various measures of obstetric care than the antepartum stillbirth rate. Increases in cesarean section rates up to 8% are associated with significant improvements in intrapartum stillbirth rates.
Topics: Delivery, Obstetric; Developed Countries; Developing Countries; Female; Humans; Outcome Assessment, Health Care; Pregnancy; Prenatal Care; Quality Indicators, Health Care; Regression Analysis; Stillbirth
PubMed: 17963057
DOI: 10.1080/00016340701644876 -
Acta Obstetricia Et Gynecologica... Feb 2016Worldwide, 98% of stillbirths occur in low-income countries (LIC), where stillbirth rates are ten-fold higher than in high-income countries (HIC). Although most HIC...
Worldwide, 98% of stillbirths occur in low-income countries (LIC), where stillbirth rates are ten-fold higher than in high-income countries (HIC). Although most HIC stillbirths occur prenatally, in LIC most stillbirths occur at term and during labor/delivery. Conditions causing stillbirths include those of maternal origin (obstructed labor, trauma, antepartum hemorrhage, preeclampsia/eclampsia, infection, diabetes, other maternal diseases), and fetal origin (fetal growth restriction, fetal distress, cord prolapse, multiples, malpresentations, congenital anomalies). In LIC, aside from infectious origins, most stillbirths are caused by fetal asphyxia. Stillbirth prevention requires recognition of maternal conditions, and care in a facility where fetal monitoring and expeditious delivery are possible, usually by cesarean section (CS). Of major causes, only syphilis and malaria can be managed prenatally. Targeting single conditions or interventions is unlikely to substantially reduce stillbirth. To reduce stillbirth rates, LIC must implement effective modern antepartum and intrapartum care, including fetal monitoring and CS.
Topics: Delivery, Obstetric; Female; Fetal Death; Fetal Diseases; Humans; Maternal Mortality; Midwifery; Poverty; Pregnancy; Pregnancy Complications; Prenatal Care; Resuscitation; Risk Factors; Stillbirth
PubMed: 26577070
DOI: 10.1111/aogs.12817