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Journal of Obstetrics and Gynaecology :... Dec 2023Pregnant women are one of the endangered groups who need special attention in the COVID-19 epidemic. We conducted a systematic review and summarised the studies that... (Meta-Analysis)
Meta-Analysis
Pregnant women are one of the endangered groups who need special attention in the COVID-19 epidemic. We conducted a systematic review and summarised the studies that reported adverse pregnancy outcomes in pregnant women with COVID-19 infection. A literature search was performed in PubMed and Scopus up to 1 September 2022, for retrieving original articles published in the English language assessing the association between COVID-19 infection and adverse pregnancy outcomes. Finally, in this review study, of 1790 articles obtained in the initial search, 141 eligible studies including 1,843,278 pregnant women were reviewed. We also performed a meta-analysis of a total of 74 cohort and case-control studies. In this meta-analysis, both fixed and random effect models were used. Publication bias was also assessed by Egger's test and the trim and fill method was conducted in case of a significant result, to adjust the bias. The result of the meta-analysis showed that the pooled prevalence of preterm delivery, maternal mortality, NICU admission and neonatal death in the group with COVID-19 infection was significantly more than those without COVID-19 infection (<.01). A meta-regression was conducted using the income level of countries. COVID-19 infection during pregnancy may cause adverse pregnancy outcomes including of preterm delivery, maternal mortality, NICU admission and neonatal death. Pregnancy loss and SARS-CoV2 positive neonates in Lower middle income are higher than in High income. Vertical transmission from mother to foetus may occur, but its immediate and long-term effects on the newborn are unclear.
Topics: Female; Humans; Infant, Newborn; Pregnancy; COVID-19; Infectious Disease Transmission, Vertical; Perinatal Death; Pregnancy Complications, Infectious; Pregnancy Outcome; Premature Birth; SARS-CoV-2; Maternal Mortality; Intensive Care Units, Neonatal; Patient Admission
PubMed: 36651606
DOI: 10.1080/01443615.2022.2162867 -
PloS One 2022Globally, three fourth of neonatal deaths occur during the early neonatal period, this makes it a critical time to reduce the burden of neonatal death. The survival...
BACKGROUND
Globally, three fourth of neonatal deaths occur during the early neonatal period, this makes it a critical time to reduce the burden of neonatal death. The survival status of a newborn is determined by the individual (neonatal and maternal), and facility-level factors. Several studies were conducted in Ethiopia to assess early neonatal death; however, most of the studies had limited participants and did not well address the two main determinant factors covered in this study. In response to this gap, this study attempted to examine factors related to early neonatal death based on perinatal death surveillance data in consideration of all the possible determinants of early neonatal death.
METHODS
The national perinatal death surveillance data were used for this study. A total of 3814 reviewed perinatal deaths were included in the study. Bayesian multilevel parametric survival analysis was employed to identify factors affecting the survival of newborns during the early neonatal period. Adjusted time ratio (ATR) with 95% Bayesian credible intervals (CrI) was reported and log-likelihood was used for model comparison. Statistical significance was declared based on the non-inclusion of 1.0 in the 95% CrI.
RESULT
More than half (52.4%) of early neonatal deaths occurred within the first two days of birth. Per the final model, as gestational age increases by a week the risk of dying during the early neonatal period is reduced by 6% [ATR = 0.94,95%CrI:(0.93-0.96)]. There was an increased risk of death during the early neonatal period among neonates deceased due to birth injury as compared to neonates who died due to infection [ATR = 2.05,95%CrI:(1.30-3.32)]; however, perinates who died due to complication of an intrapartum event had a lower risk of death than perinates who died due to infection [ATR = 0.87,95%CrI:(0.83-0.90)]. As the score of delay one and delay three increases by one unit, the newborn's likelihood of surviving during the early neonatal period is reduced by 4% [ATR = 1.04,95%CrI:(1.01-1.07)] and 21% [ATR = 1.21,95%CrI:(1.15-1.27)] respectively. Neonates born from mothers living in a rural area had a higher risk of dying during the early neonatal period than their counterparts living in an urban area [ATR = 3.53,95%CrI:(3.34-3.69)]. As compared to neonates treated in a primary health facility, being treated in secondary [ATR = 1.14,95%CrI:(1.02-1.27)] and tertiary level of care [ATR = 1.15,95%CrI:(1.04-1.25)] results in a higher risk of death during the early neonatal period.
CONCLUSION
The survival of a newborn during the early neonatal period is determined by both individual (gestational age, cause of death, and delay one) and facility (residence, type of health facility and delay three) level factors. Thus, to have a positive early neonatal outcome, a tailored intervention is needed for the three major causes of death (i.e Infection, birth injury, and complications of the intrapartum period). Furthermore, promoting maternal health, improving the health-seeking behaviour of mothers, strengthening facility readiness, and narrowing down inequalities in service provision are recommended to improve the newborn's outcomes during the early neonatal period.
Topics: Bayes Theorem; Birth Injuries; Ethiopia; Female; Humans; Infant, Newborn; Mothers; Perinatal Death; Pregnancy; Risk Factors
PubMed: 36174051
DOI: 10.1371/journal.pone.0275475 -
BMC Health Services Research Sep 2022Over one million babies are stillborn or die within the first 28 days of life each year due to preventable causes and poor-quality care in resource-constrained...
BACKGROUND
Over one million babies are stillborn or die within the first 28 days of life each year due to preventable causes and poor-quality care in resource-constrained countries. Death audit may be a valuable tool for improving quality of care and decreasing mortality. However, challenges in implementing audit and their subsequent action plans have been reported, with few successfully implemented and sustained. This study aimed to identify factors that affect stillbirth and neonatal death audit at the facility level in the southern region of Malawi.
METHODS
Thirty-eight semi-structured interviews and seven focus group discussions with death audit committee members were conducted. Thematic analysis was guided by a conceptual framework applied deductively, combined with inductive line-by-line coding to identify additional emerging themes.
RESULTS
The factors that affected audit at individual, facility and national level were related to training, staff motivation, power dynamics and autonomy, audit organisation and data support. We found that factors were linked because they informed each other. Inadequate staff training was caused by a lack of financial allocation at the facility level and donor-driven approaches to training at the national level, with training taking place only with support from funders. Staff motivation was affected by the institutional norms of reliance on monetary incentives during meetings, gazetted at the national level so that audits happened only if such incentives were available. This overshadowed other benefits and non-monetary incentives which were not promoted at the facility level. Inadequate resources to support audit were informed by limited facility-level autonomy and decision-making powers which remained controlled at the national level despite decentralisation. Action plan implementation challenges after audit meetings resulted from inadequate support at the facility level and inadequate audit policy and guidelines at the national level. Poor documentation affected audit processes informed by inadequate supervision and promotion of data usage at both facility and national levels.
CONCLUSIONS
Given that the factors that facilitate or inhibit audits are interconnected, implementers, policymakers and managers need to be aware that addressing barriers is likely to require a whole health systems approach targeting all system levels. This will require behavioural and complex intervention approaches.
Topics: Female; Focus Groups; Humans; Infant, Newborn; Malawi; Perinatal Death; Pregnancy; Qualitative Research; Stillbirth
PubMed: 36138396
DOI: 10.1186/s12913-022-08578-y -
Journal of Perinatal Medicine Feb 2018We examined the causes of death amongst full term stillbirths and early neonatal deaths.
OBJECTIVE
We examined the causes of death amongst full term stillbirths and early neonatal deaths.
METHODS
Our cohort includes women in the Region of Southern Denmark, who gave birth at full term to a stillborn infant or a neonate who died within the first 7 days from 2010 through 2014. Demographic, biometric and clinical variables were analyzed to assess the causes of death using two classification systems: causes of death and associated conditions (CODAC) and a Danish system based on initial causes of fetal death (INCODE).
RESULTS
A total of 95 maternal-infant cases were included. Using the CODAC and INCODE classification systems, we found that the causes of death were unknown in 59/95 (62.1%). The second most common cause of death in CODAC was congenital anomalies in 10/95 (10.5%), similar to INCODE with fetal, genetic, structural and karyotypic anomalies in 11/95 (11.6%). The majority of the mothers were healthy, primiparous, non-smokers, aged 20-34 years and with a normal body mass index (BMI).
CONCLUSION
Based on an unselected cohort from an entire region in Denmark, the cause of stillbirth and early neonatal deaths among full term infants remained unknown for the vast majority.
Topics: Adult; Cause of Death; Cohort Studies; Denmark; Female; Humans; Infant; Infant Mortality; Infant, Newborn; Infant, Newborn, Diseases; Perinatal Care; Perinatal Death; Pregnancy; Prenatal Care; Stillbirth; Term Birth
PubMed: 28753550
DOI: 10.1515/jpm-2017-0171 -
Jornal de Pediatria 2016
Topics: Brazil; Female; Humans; Infant; Infant Mortality; Infant, Newborn; Maternal Death; Perinatal Death
PubMed: 27521567
DOI: 10.1016/j.jped.2016.08.001 -
Seminars in Fetal & Neonatal Medicine Jun 2017Perinatal death (PD) is a devastating obstetric complication. Determination of cause of death helps in understanding why and how it occurs, and it is an indispensable... (Review)
Review
Perinatal death (PD) is a devastating obstetric complication. Determination of cause of death helps in understanding why and how it occurs, and it is an indispensable aid to parents wanting to understand why their baby died and to determine the recurrence risk and management in subsequent pregnancy. Consequently, a perinatal death requires adequate diagnostic investigation. An important first step in the analysis of PD is to identify the case circumstances, including relevant details regarding maternal history, obstetric history and current pregnancy (complications are evaluated and recorded). In the next step, placental examination is suggested in all cases, together with molecular cytogenetic evaluation and fetal autopsy. Investigation for fetal-maternal hemorrhage by Kleihauer is also recommended as standard. In cases where parents do not consent to autopsy, alternative approaches such as minimally invasive postmortem examination, postmortem magnetic resonance imaging, and fetal photographs are good alternatives. After all investigations have been performed it is important to combine findings from the clinical review and investigations together, to identify the most probable cause of death and counsel the parents regarding their loss.
Topics: Adult; Cause of Death; Cytogenetic Analysis; Evidence-Based Medicine; Female; Fetal Diseases; Humans; Infant, Newborn; Male; Perinatal Death; Placenta; Pregnancy; Pregnancy Complications; Risk Factors; Stillbirth
PubMed: 28325580
DOI: 10.1016/j.siny.2017.02.005 -
The Australian & New Zealand Journal of... Jun 2022Neonatal near miss (NNM) refers to a newborn who almost died in the neonatal period and is often perceived as part of a spectrum that includes stillbirth and neonatal... (Review)
Review
Neonatal near miss (NNM) refers to a newborn who almost died in the neonatal period and is often perceived as part of a spectrum that includes stillbirth and neonatal death. NNM audits might improve recognition of risk factors and substandard care, facilitate benchmarking and inform prevention strategies to improve perinatal outcomes. This review shows that available NNM definitions are inconsistent and vary widely. This is likely to undermine the development of effective prevention strategies and global comparisons. Expert opinion may help reaching a consensus, thus enabling targeting of the appropriate population which would lead to more meaningful data for perinatal audits.
Topics: Female; Humans; Infant Mortality; Infant, Newborn; Near Miss, Healthcare; Perinatal Death; Pregnancy; Reference Standards; Risk Factors; Stillbirth
PubMed: 35243623
DOI: 10.1111/ajo.13493 -
Reproductive Health 2014Childbirth and the postnatal period, spanning from right after birth to the following several weeks, presents a time in which the number of deaths reported still remain... (Review)
Review
Childbirth and the postnatal period, spanning from right after birth to the following several weeks, presents a time in which the number of deaths reported still remain alarmingly high. Worldwide, about 800 women die from pregnancy- or childbirth-related complications daily while almost 75% of neonatal deaths occur within the first seven days of delivery and a vast majority of these occur in the first 24 hours. Unfortunately, this alarming trend of mortality persists, as 287,000 women lost their lives to pregnancy and childbirth related causes in 2010. Almost all of these deaths were preventable and occurred in low-resource settings, pointing towards dearth of adequate facilities in these parts of the world. The main objective of this paper is to review the evidence based childbirth and post natal interventions which have a beneficial impact on maternal and newborn outcomes. It is a compilation of existing, new and updated interventions designed to help physicians and policy makers and enable them to reduce the burden of maternal and neonatal morbidities and mortalities. Interventions during the post natal period that were found to be associated with a decrease in maternal and neonatal morbidity and mortality included: advice and support of family planning, support and promotion of early initiation and continued breastfeeding; thermal care or kangaroo mother care for preterm and/or low birth weight babies; hygienic care of umbilical cord and skin following delivery, training health personnel in basic neonatal resuscitation; and postnatal visits. Adequate delivery of these interventions is likely to bring an unprecedented decrease in the number of deaths reported during childbirth.
Topics: Bacterial Infections; Breast Feeding; Delivery, Obstetric; Female; Humans; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Maternal Death; Parturition; Perinatal Death; Postnatal Care; Postpartum Hemorrhage; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Prenatal Care
PubMed: 25177795
DOI: 10.1186/1742-4755-11-S1-S3 -
Acta Obstetricia Et Gynecologica... Apr 2018Several phenomena in contemporary perinatology create challenges for analyzing pregnancy outcomes. These include recent increases in iatrogenic delivery at late preterm... (Review)
Review
Several phenomena in contemporary perinatology create challenges for analyzing pregnancy outcomes. These include recent increases in iatrogenic delivery at late preterm and early term gestation, which are incongruent with the belief that stillbirth and neonatal death risks decrease exponentially with advancing gestational age. Perinatal epidemiologists have also puzzled over the paradox of intersecting birthweight-specific and gestational age-specific perinatal mortality curves for decades. For example, neonatal mortality rates among preterm infants of women who smoke are substantially lower than neonatal mortality rates among preterm infants of non-smoking women, whereas the reverse pattern occurs at term gestation. This mortality crossover is observed across several contrasts (for example, women with hypertensive disorders of pregnancy vs. normotensive women, older vs. younger women, twins vs. singletons) and outcomes (stillbirth, neonatal death, sudden infant death syndrome and cerebral palsy), and irrespective of how advancing "maturity" is defined (birthweight or gestational age). One approach proposed to address and explain these unexpected phenomena is the fetuses-at-risk model. This formulation involves a reconceptualization of the denominator for perinatal outcome rates from births to surviving fetuses. In this overview of the fetuses-at-risk model, we discuss the central tenets of the births-based and the fetuses-based formulations. We also describe the extension of the fetuses-at-risk approach to outcomes into and beyond the neonatal period and to a multivariable adaptation. Finally, we provide a substantive context by discussing biological mechanisms underlying the fetuses-at-risk model and contemporary obstetric phenomena that are better understood from that model than from one based on births.
Topics: Birth Weight; Fetus; Gestational Age; Humans; Infant; Infant, Newborn; Infant, Premature; Models, Biological; Perinatal Death; Risk; Stillbirth; Survival Analysis
PubMed: 28742216
DOI: 10.1111/aogs.13194 -
JAMA Pediatrics Feb 2020This study examines the association of placental weight with the risk of prenatal death using data from the Medical Birth Registry of Norway.
This study examines the association of placental weight with the risk of prenatal death using data from the Medical Birth Registry of Norway.
Topics: Female; Humans; Infant, Newborn; Organ Size; Perinatal Death; Placenta; Pregnancy; Risk Assessment
PubMed: 31790552
DOI: 10.1001/jamapediatrics.2019.4556