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Perinatal Death (perinatal + death)

Distribution by Scientific Domains

Medical Sciences	92%
3 Other Domains	8%

Distribution within Medical Sciences

Obstetrics & Gynecology	76%
Pediatrics	9%
4 Other Subdomains	15%

Selected Abstracts

Sonographic atypical vascular coiling of the umbilical cord

PRENATAL DIAGNOSIS, Issue 1 2005
Antonella Cromi
Abstract Objective To investigate whether an atypical umbilical coiling pattern at prenatal sonography is associated with adverse pregnancy outcome. Methods A targeted sonographic evaluation of the umbilical cord (UC) was performed in 758 women with singleton gestation, and gestational age above 20 weeks. Atypical coiling was defined as the presence of a spring-shape UC (supercoiling) or an unusual, aperiodic coiling pattern (uncoordinated coiling). Umbilical artery Doppler assessment was conducted in cases with atypical coiling. Pregnancy and neonatal outcomes were investigated. Results Of the study population, 7 and 16 fetuses had an umbilical cord with uncoordinated coiling and supercoiling respectively. Three umbilical cords had a single umbilical artery. Eight patients delivered before 34 weeks of gestation. Eight fetuses were growth restricted. In seven cases, abnormal sonographic findings were detected (three meconium peritonitis, two severe hydronephrosis and two cardiac anomalies). One fetus affected by trisomy 18 presented multiple anomalies. Perinatal death occurred in three cases. Of the surviving newborns, eight were admitted to NICU. Umbilical artery Doppler waveforms presented a systolic notch in seven (30.4%) cases. Conclusions The presence of an atypical umbilical cord vascular coiling is associated with an increased risk of unfavourable pregnancy outcome. The identification of an umbilical artery notch at Doppler investigation is frequently associated with an atypical UC coiling pattern. Copyright © 2005 John Wiley & Sons, Ltd. [source]

Maternal periodontal disease and perinatal mortality

AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 2 2009
Alexis SHUB
Background: Periodontal disease has been associated with increased perinatal mortality. Aims: To examine the association between maternal periodontal disease and perinatal mortality. Methods: We performed a retrospective and prospective matched case,control study of women with unexplained perinatal mortality at more than 20 weeks gestational age. Women were matched for socioeconomic status, smoking status and time since delivery. All women underwent a detailed periodontal examination and completed a questionnaire describing oral health symptoms. No intervention took place. Results: Fifty-three women who had experienced a perinatal death and 111 controls completed the study. Thirty-two women were recruited retrospectively and 21 women were recruited prospectively. Twenty-three (43.4%) women who had experienced a perinatal death and 27 (24.3%) controls had periodontal disease. There were no differences in oral health behaviours or symptoms between cases and controls. Perinatal death was associated with periodontal disease (odds ratio (OR) 2.34, 95% confidence interval (CI) 1.05, 5.47). Periodontal disease was more strongly associated with perinatal mortality due to extreme prematurity (OR 3.60, 95% CI 1.20, 12.04). Multivariate analysis showed this relationship to be consistent after inclusion of higher parity, country of birth, advanced maternal age and maternal obesity in the model (OR 4.56, 95% CI 1.25, 21.27). Conclusions: Maternal periodontal disease may contribute to perinatal mortality, especially that caused by extreme prematurity. [source]

Fetal Mouse Imaging Using Echocardiography: A Review of Current Technology

ECHOCARDIOGRAPHY, Issue 10 2006
Christopher F. Spurney M.D.
Advances in genetic research have led to the need for phenotypic analysis of small animal models. However, often these genetic alterations, especially when affecting the cardiovascular system, can result in fetal or perinatal death. Noninvasive ultrasound imaging is an ideal method for detecting and studying such congenital malformations, as it allows early recognition of abnormalities in the living fetus and the progression of disease can be followed in utero with longitudinal studies. Two platforms for fetal mouse echocardiography exist, the clinical systems with 15-MHz phased array transducers and research systems with 20,55-MHz mechanical transducers. The clinical ultrasound system has limited two-dimensional (2D) resolution (axial resolution of 440 ,m), but the availability of color and spectral Doppler allows quick interrogations of blood flows, facilitating the detection of structural abnormalities. M-mode imaging further provides important functional data, although, the proper imaging planes are often difficult to obtain. In comparison, the research biomicroscope system has significantly improved 2D resolution (axial resolution of 28 ,m). Spectral Doppler imaging is also available, but in the absence of color Doppler, imaging times are increased and the detection of flow abnormalities is more difficult. M-mode imaging is available and equivalent to the clinical ultrasound system. Overall, the research system, given its higher 2D resolution, is best suited for in-depth analysis of mouse fetal cardiovascular structure and function, while the clinical ultrasound systems, equipped with phase array transducers and color Doppler imaging, are ideal for high-throughput fetal cardiovascular screens. [source]

Couple distress after sudden infant or perinatal death: A 30-month follow up

JOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 4 2002
JC Vance
Objective: To examine, using a 30-month prospective study, patterns of anxiety, depression and alcohol use in couples following stillbirth, neonatal death or sudden infant death syndrome. Methodology: One hundred and thirty-eight bereaved and 156 non-bereaved couples completed standardized interviews at 2, 8, 15 and 30 months post-loss. Results: At all interviews, bereaved couples were significantly more likely than non-bereaved couples to have at least one distressed partner. Rarely were both partners distressed in either group. For bereaved couples, ,mother only' distress declined from 21% to 10% during the study. ,Father only' distress ranged from 7% to 15%, peaking at 30 months. Bereaved mothers who were distressed at 2 months reported significantly lower marital satisfaction at 30 months. Conclusions: At the couple level, the experience of a baby's death is multifaceted. Gender differences are common and partners' needs may change over time. Early recognition of these differences may facilitate longer-term adjustment for both partners. [source]

Prospective community-based cluster census and case-control study of stillbirths and neonatal deaths in the West Bank and Gaza Strip

PAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 4 2008
Henry D. Kalter
Summary Obstetric complications and newborn illnesses amenable to basic medical interventions underlie most perinatal deaths. Yet, despite good access to maternal and newborn care in many transitional countries, perinatal mortality is often not monitored in these settings. The present study identified risk factors for perinatal death and the level and causes of stillbirths and neonatal deaths in the West Bank and Gaza Strip. Baseline and follow-up censuses with prospective monitoring of pregnant women and newborns from September 2001 to August 2002 were conducted in 83 randomly selected clusters of 300 households each. A total of 113 of 116 married women 15,49 years old with a stillbirth or neonatal death and 813 randomly selected women with a surviving neonate were interviewed, and obstetric and newborn care records of women with a stillbirth or neonatal death were abstracted. The perinatal and neonatal mortality rates, respectively, were 21.2 [95% confidence interval (CI) 16.5, 25.9] and 14.7 [95% CI 10.2, 19.2] per 1000 livebirths. The most common cause (27%) of 96 perinatal deaths was asphyxia alone (21) or with neonatal sepsis (5), while 18/49 (37%) early and 9/19 (47%) late neonatal deaths were from respiratory distress syndrome (12) or sepsis (9) alone or together (6). Constraint in care seeking, mainly by an Israeli checkpoint, occurred in 8% and 10%, respectively, of 112 pregnancies and labours and 31% of 16 neonates prior to perinatal or late neonatal death. Poor quality care for a complication associated with the death was identified among 40% and 20%, respectively, of 112 pregnancies and labour/deliveries and 43% of 68 neonates. (Correction added after online publication 5 June 2008: The denominators 112 pregnancies, labours, and labour/deliveries, and 16 and 68 neonates were included; and 9% of labours was corrected to 10%.) Risk factors for perinatal death as assessed by multivariable logistic regression included preterm delivery (odds ratio [OR] = 11.9, [95% CI 6.7, 21.2]), antepartum haemorrhage (OR = 5.6, [95% CI 1.5, 20.9]), any severe pregnancy complication (OR = 3.4, [95% CI 1.8, 6.6]), term delivery in a government hospital and having a labour and delivery complication (OR = 3.8, [95% CI 1.2, 12.0]), more than one delivery complication (OR = 4.4, [95% CI 1.8, 10.5]), mother's age >35 years (OR = 2.9, [95% CI 1.3, 6.8]) and primiparity in a full-term pregnancy (OR = 2.6, [1.1, 6.3]). Stillbirths are not officially reportable in the West Bank and Gaza Strip and this is the first time that perinatal mortality has been examined. Interventions to lower stillbirths and neonatal deaths should focus on improving the quality of medical care for important obstetric complications and newborn illnesses. Other transitional countries can draw lessons for their health care systems from these findings. [source]

Tetrahydrobiopterin in the prevention of hypertonia in hypoxic fetal brain,

ANNALS OF NEUROLOGY, Issue 3 2009
Jeannette Vásquez-Vivar PhD
Objective Tetrahydrobiopterin (BH4) deficiency is a cause of dystonia at birth. We hypothesized that BH4 is a developmental factor determining vulnerability of the immature fetal brain to hypoxic-ischemic injury and subsequent motor deficits in newborns. Methods Pregnant rabbits were subjected to 40-minute uterine ischemia, and fetal brains were investigated for global and focal changes in BH4. Newborn kits were assessed by neurobehavioral tests following vehicle and sepiapterin (BH4 analog) treatment of dams. Results Naive fetal brains at 70% gestation (E22) were severely deficient for BH4 compared with maternal and other fetal tissues. BH4 concentration rapidly increased normally in the perinatal period, with the highest concentrations found in the thalamus compared with basal ganglia, frontal, occipital, hippocampus, and parietal cortex. Global sustained 40-minute hypoxia-ischemia depleted BH4 in E22 thalamus and to a lesser extent in basal ganglia, but not in the frontal, occipital, and parietal regions. Maternal supplementation prior to hypoxia-ischemia with sepiapterin increased BH4 in all brain regions and especially in the thalamus, but did not increase the intermediary metabolite, 7,8-BH2. Sepiapterin treatment also reduced incidence of severe motor deficits and perinatal death following E22 hypoxia-ischemia. Interpretation We conclude that early developmental BH4 deficiency plays a critical role in hypoxic-ischemic brain injury. Increasing brain BH4 via maternal supplementation may be an effective strategy in preventing motor deficits from antenatal hypoxia-ischemia. Ann Neurol 2009;66:323,331 [source]

Women's expectations of management in their next pregnancy after an unexplained stillbirth: An Internet-based empirical study

AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 6 2009
Stephen J. ROBSON
Background:, Unexplained stillbirth is the largest contributor to perinatal death, accounting for one-third of stillbirths. There appears to be no increase in perinatal death rates in the pregnancies that follow an unexplained stillbirth. However, these pregnancies have increased rates of induced labour and elective caesarean section, as well as preterm birth, low birthweight, instrumental delivery, ,fetal distress' and postpartum haemorrhage. Aim:, To study the wishes for future pregnancy management in women who have suffered an unexplained stillbirth. Methods: An Internet-based survey of women after an unexplained stillbirth, seeking demographic information and reproductive history, details of management of the index stillbirth and information about their wishes for subsequent pregnancy management (antenatal surveillance, early delivery and caesarean delivery). Results:, Of the total respondents included in the study, 93% wanted ,testing' over and above normal pregnancy care in their next pregnancy. Of the respondents, 81% wanted early delivery and 26% wanted a Caesarean delivery, irrespective of obstetric indications. These wishes were not influenced by socio-demographic factors, management of the index stillbirth (with the exception of having had a Caesarean delivery) or advice received on management of the next pregnancy (with the exception of being advised to have an early or Caesarean delivery). Conclusions:, The women surveyed wanted increased fetal surveillance and early delivery, but not necessarily elective caesarean section. [source]

Systematic multidisciplinary approach to reporting perinatal mortality: Lessons from a five-year regional review

AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 5 2009
Alison L. KENT
Background:, Because of differences in reporting criteria throughout the world, comparing perinatal mortality rates and identifying areas of concern can be complicated and imprecise. Aims:, To detail the systematic approach to reporting perinatal deaths and to identify any significant differences in outcomes in the Australian Capital Territory (ACT). Methods:, Review of perinatal deaths from 2001 to 2005 in the ACT using the Australian and New Zealand Antecedent Classification of Perinatal Mortality (ANZACPM) and the Australian and New Zealand Neonatal Death Classification (ANZNDC) systems. Results:, ACT residents' perinatal mortality rate was 10.6 per 1000 total births, fetal death rate 7.5 per 1000 total births and neonatal death rate 3.2 per 1000 live births. The three leading antecedent causes of perinatal death were congenital anomalies, spontaneous preterm birth and unexplained antepartum death. The three leading causes of neonatal death were extreme prematurity, cardiorespiratory disorders and congenital anomalies. Multiple births attributed to 20% (65 of 321) of perinatal deaths. Perinatal autopsy was performed in 50% of cases, but in only 64% of unexplained antepartum deaths. Conclusions:, Causes of perinatal death for the ACT and surrounding New South Wales region are similar to other states using this classification system. The following are considered important lessons to promote accurate perinatal mortality reporting: (i) a universal reporting system for Australia utilising a multidisciplinary team; (ii) a high perinatal autopsy rate, especially in the critical area of antepartum death with no identifiable cause; and (iii) standardised definitions for avoidability. Attention to these areas may prompt further research and changes in practice to further reduce perinatal mortality. [source]

Maternal periodontal disease and perinatal mortality

Small for gestational age preterm infants and relationship of abnormal umbilical artery Doppler blood flow to perinatal mortality and neurodevelopmental outcomes

AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 1 2009
Antonia W. SHAND
Aim: To determine the outcomes of preterm small for gestational age (SGA) infants with abnormal umbilical artery (UA) Doppler studies. Methods: A retrospective cohort study of SGA singleton infants delivered between 24 and 32 weeks gestation at King Edward Memorial Hospital, Perth, who had UA Doppler studies performed within seven days of birth. Main outcomes assessed were perinatal mortality and morbidity, and neurodevelopmental outcomes at , 1 year of age. Outcomes were compared by normality of UA blood flow. Results: There were 119 infants in the study: 49 (41%) had normal UA Doppler studies, 31 (26%) had an increased systolic,diastolic ratio , 95th centile, 19 (16%) had absent end diastolic blood flow (AEDF) and 20 (17%) had reversed end-diastolic flow (REDF). Infants in the AEDF and REDF groups were delivered significantly more preterm (P = 0.006) and had lower birthweights (P < 0.001). Ninety four per cent (110 of 117) of live born infants survived. Neurodevelopmental follow-up at 12 months of age or more (median 24 months) was available on 87 of 108 (81%) of live children. Twenty-eight per cent (11 of 39) of fetuses who had had AEDF or REDF died or were classified with moderate or severe disability. There was no significant association between abnormality of UA blood flow, perinatal morbidity, perinatal mortality and neurodevelopmental disability after correction for gestational age. Conclusion: Fetuses that are SGA with abnormal UA Doppler studies remain at significant risk of perinatal death, perinatal morbidity and long-term neurodevelopmental disability, associated with their increased risk of preterm birth. [source]

Avoidable risk factors in perinatal deaths: A perinatal audit in South Australia

AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 1 2008
Titia E. DE LANGE
Objectives: To analyse risk factors of perinatal death, with an emphasis on potentially avoidable risk factors, and differences in the frequency of suboptimal care factors between maternity units with different levels of care. Methods: Six hundred and eight pregnancies (2001,2005) in South Australia resulting in perinatal death were described and compared to 86 623 live birth pregnancies. Results: Two hundred and seventy cases (44.4%) were found to have one or more avoidable maternal risk factors, 31 cases (5.1%) had a risk factor relating access to care, while 68 cases (11.2%) were associated with deficiencies in professional care. One hundred and four women (17.1% of cases) presented too late for timely medical care: 85% of these did have a sufficient number of antenatal visits. The following independent maternal risk factors for perinatal death were found: assisted reproductive technology (adjusted odds ratio (AOR) 3.16), preterm labour (AOR 22.05), antepartum haemorrhage (APH) abruption (AOR 6.40), APH other/unknown cause (AOR 2.19), intrauterine growth restriction (AOR 3.94), cervical incompetence (AOR 8.89), threatened miscarriage (AOR 1.89), pre-existing hypertension (AOR 1.72), psychiatric disorder (AOR 1.85) and minimal antenatal care (AOR 2.89). The most commonly found professional care deficiency in cases was the failure to act on or recognise high-risk pregnancies/complications, found in 49 cases (8.1%). Conclusion: Further improvements in perinatal mortality may be achieved by greater emphasis on the importance of antenatal care and educating women to recognise signs and symptoms that require professional assessment. Education of maternity care providers may benefit from a further focus on how to recognise and/or manage high-risk pregnancies. [source]

The urban and rural divide for women giving birth in NSW, 1990,1997

AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 3 2000
Christine L. Roberts
ABSTRACT OBJECTIVE: To examine trends in the pregnancy profile and outcomes of urban and rural women. METHODS: Data were obtained from the NSW Midwives Data Collection on births in NSW, 1990,1997. Associations between place of residence (urban/rural) and maternal factors and pregnancy outcomes were examined, including changes over time. RESULTS: From 1990 to 1997 there were 685,631 confinements in NSW and these mothers resided as follows: 76% metropolitan, 5% large rural centres, 8% small rural centres, 11% other rural areas and 1% remote areas. Rural mothers were more likely to be teenagers, multiparous, without a married or de facto partner, public patients and smokers. Births in rural areas declined, particularly among women aged 20,34 years. Infants born to mothers in remote communities were at increased odds of stillbirth and tow Apgar scores (all women) and small,for,gestational,age (SGA) (Indigenous women only). CONCLUSIONS: The profile of pregnant women in rural NSW is different from their urban counterparts and is consistent with relative socioeconomic disadvantage and possibly suboptimal maternity services in some areas. While increased risk of SGA is associated with environmental factors such as smoking and nutrition, the reasons for increased risk of stillbirth are unclear. Although there does not appear to be an increased risk of preterm birth for rural women this may be masked by transfer of high,risk pregnancies interstate. IMPLICATIONS: Maternity services need to be available and accessible to all rural women with targeting of interventions known to reduce low birthweight and perinatal death. [source]

Estimation of Spatial Variation in Risk Using Matched Case-control Data

BIOMETRICAL JOURNAL, Issue 8 2002
Mikala F. Jarner
Abstract A common problem in environmental epidemiology is to estimate spatial variation in disease risk after accounting for known risk factors. In this paper we consider this problem in the context of matched case-control studies. We extend the generalised additive model approach of Kelsall and Diggle (1998) to studies in which each case has been individually matched to a set of controls. We discuss a method for fitting this model to data, apply the method to a matched study on perinatal death in the North West Thames region of England and explain why, if spatial variation is of particular scientific interest, matching is undesirable. [source]

World Health Organisation multicentre randomised trial of supplementation with vitamins C and E among pregnant women at high risk for pre-eclampsia in populations of low nutritional status from developing countries

BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 6 2009
J Villar
Objective, To determine if vitamin C and E supplementation in high-risk pregnant women with low nutritional status reduces pre-eclampsia. Design, Multicentred, randomised, controlled, double-blinded trial. Setting, Antenatal care clinics and Hospitals in four countries. Population, Pregnant women between 14 and 22 weeks' gestation. Method, Randomised women received 1000 mg vitamin C and 400 iu of vitamin E or placebo daily until delivery. Main outcome measures, Pre-eclampsia, low birthweight, small for gestational age and perinatal death. Results, Six hundred and eighty-seven women were randomised to the vitamin group and 678 to the placebo group. Groups had similar gestational ages (18.1; SD 2.4 weeks), socio-economic, clinical and demographical characteristics and blood pressure at trial entry. Risk factors for eligibility were similar, except for multiple pregnancies: placebo group (14.7%), vitamins group (11.8%). Previous pre-eclampsia, or its complications, was the most common risk factor at entry (vitamins 41.6%, placebo 41.3%). Treatment compliance was 87% in the two groups and loss to follow-up was low (vitamins 2.0%, placebo 1.3%). Supplementation was not associated with a reduction of pre-eclampsia (RR: 1.0; 95% CI: 0.9,1.3), eclampsia (RR: 1.5; 95% CI: 0.3,8.9), gestational hypertension (RR: 1.2; 95% CI: 0.9,1.7), nor any other maternal outcome. Low birthweight (RR: 0.9; 95% CI: 0.8,1.1), small for gestational age (RR: 0.9; 95% CI: 0.8,1.1) and perinatal deaths (RR: 0.8; 95% CI: 0.6,1.2) were also unaffected. Conclusion, Vitamins C and E at the doses used did not prevent pre-eclampsia in these high-risk women. [source]

Evaluation of 280 000 cases in Dutch midwifery practices: a descriptive study

BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 5 2008
MP Amelink-Verburg
Objective, To assess the nature and outcome of intrapartum referrals from primary to secondary care within the Dutch obstetric system. Design, Descriptive study. Setting, Dutch midwifery database (LVR1), covering 95% of all midwifery care and 80% of all Dutch pregnancies (2001,03). Population, Low-risk women (280 097) under exclusive care of a primary level midwife at the start of labour either with intention to deliver at home or with a personal preference to deliver in hospital under care of a primary level midwife. Methods, Women were classified into three categories (no referral, urgent referral and referral without urgency) and were related to maternal characteristics and to neonatal outcomes. Main outcome measures, Distribution of referral categories, main reasons for urgent referral, Apgar score at 5 minutes, perinatal death within 24 hours and referral to a paediatrician within 24 hours. Results, In our study, 68.1% of the women completed childbirth under exclusive care of a midwife, 3.6% were referred on an urgency basis and 28.3% were referred without urgency. Of all referrals, 11.2% were on an urgency basis. The main reasons for urgent referrals were fetal distress and postpartum haemorrhage. The nonurgent referrals predominantly took place during the first stage of labour (73.6% of all referrals). Women who had planned a home delivery were referred less frequently than women who had planned a hospital delivery: 29.3 and 37.2%, respectively (P < 0.001). On average, the mean Apgar score at 5 minutes was high (9.72%) and the peripartum neonatal mortality was low (0.05%) in the total study group. No maternal deaths occurred. Adverse neonatal outcomes occurred most frequently in the urgent referral group, followed by the group of referrals without urgency and the nonreferred group. Conclusions, Risk selection is a crucial element of the Dutch obstetric system and continues into the postpartum period. The system results in a relatively small percentage of intrapartum urgent referrals and in overall satisfactory neonatal outcomes in deliveries led by primary level midwives. [source]

Maternal HIV status and pregnancy outcomes in northeastern Tanzania: a registry-based study

BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 5 2008
NA Habib
Objectives, The proportion of women delivering with known HIV status in sub-Saharan Africa is not well described. Risk of HIV transmission to newborns is a major concern, but there may also be increased risks for other adverse pregnancy outcomes. Design, Hospital registry. Setting, North East Tanzania (1999,2006). Population, Singletons (n= 14 444). Methods, Births were grouped by maternal HIV status and socio-demographic factors predicting HIV status, and associations between status and pregnancy outcomes were studied. Main outcome measures, Maternal HIV status, perinatal mortality, prematurity, small for gestational age (SGA), birthweight and low Apgar score. Results, The proportion of mothers with known HIV status increased from 7% before 2001 to 78% after 2004. Single motherhood, rural residence, low maternal education, maternal and paternal farming and higher paternal age were associated with unknown HIV status. About 7.4% (95% CI 6.7,8.1%) of women were HIV infected, with increased likelihood of infection with higher gravidity, single motherhood, rural residence, maternal business or farming occupations and paternal tribe. Compared with HIV-uninfected women, the untreated HIV-infected women had a higher risk of SGA births (adjusted risk ratio [ARR] 1.6; 95% CI 1.1,2.4), preterm birth (ARR 1.8; 95% CI 1.1,2.7) and perinatal death (ARR 1.9; 95% CI 0.95,3.8). Women with unknown HIV status had moderately increased risks. Treated HIV-infected women had a risk similar to that of the HIV-uninfected women for all outcomes, except for low Apgar score. Conclusion, HIV testing and infection were associated with socio-demographic factors. Untreated HIV-infected women had higher risks of adverse pregnancy outcomes, and risks were also increased for women with unknown HIV status. There is still a need to increase availability of HIV testing, education and adequate therapy for pregnant women. [source]

Short communication: The relationship between pre-pregnancy care and early pregnancy loss, major congenital anomaly or perinatal death in type I diabetes mellitus

BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 1 2007
DWM Pearson
The relationships between markers of pregnancy planning and pre-pregnancy care and adverse outcomes (early pregnancy loss, major congenital anomaly and perinatal death) were examined in 423 singleton pregnancies in women with pre-gestational type I diabetes mellitus. Pregnancy planning and markers of pre-pregnancy care were associated with reduced risks of adverse pregnancy outcomes. ,Documentation of achievement of an optimal haemoglobin A1c prior to discontinuation of contraception' was the marker associated with the lowest rate of adverse outcome (OR 0.2; 95% CI 0.06,0.67) and might serve as an appropriate definition of pre-pregnancy care for research and audit purposes. [source]

Prognosis for the co-twin following single-twin death: a systematic review

BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 9 2006
SSC Ong
Background, Following single-twin death, the perinatal mortality and morbidity for the surviving co-twin is increased but difficult to quantify. We present data on prognosis from a systematic review. Objectives, We aimed to determine the incidence of a) co-twin death, b) neurological abnormality and c) preterm delivery for the surviving co-twin following single-twin death after 14 weeks of gestation. Search strategy, Literature was identified by searching two bibliographical databases and specialist journals between 1990 and 2005. Selection criteria, The selected studies of ,5 cases reported on perinatal death and/or neurodevelopmental delay of the surviving co-twin. Data collection and analysis, Studies were assessed for quality and data extracted to allow computation of rates. The data were inspected for heterogeneity using a Forrest plot and examined statistically using the chi-square test. Data from individual studies were pooled within subgroups defined by prognosis. Main results, The search strategy yielded 632 potentially relevant citations. Full manuscripts were retrieved for 54 citations and 28 studies were finally included in the review. Following the death of one twin, the risk of monochorionic and dichorionic co-twin demise was 12% (95% CI 7,11) and 4% (95% CI 2,7), respectively. The risk of neurological abnormality in the surviving monochorionic and dichorionic co-twin was 18% (95% CI 11,26) and 1% (95% CI 0,7), respectively. The risk of preterm delivery was 68% (95% CI 56,78) and 57% (95% CI 34,77), respectively. Where there was comparative data within studies, the odds of monochorionic co-twin intrauterine death was six times that of dichorionic twins (OR 6.04 [95% CI 1.84,19.87]). Neurological abnormality was also higher in monochorionic compared with dichorionic pregnancies (OR 4.07 [95% CI 1.32,12.51]). Author's conclusions, More prospective research is required to inform decision making on this subject, especially with data that allow stratification based upon chorionicity. [source]

Perinatal mortality: clinical value of postmortem magnetic resonance imaging compared with autopsy in routine obstetric practice

BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 4 2003
Marianne E. Alderliesten
Objective To compare postmortem magnetic resonance imaging (MRI) with autopsy in perinatal deaths. To determine the acceptance and feasibility of postmortem perinatal MRI. Design Cohort study. Setting Large teaching hospital. Population Fetuses and neonates from 16 weeks gestational age until 28 days after birth, stillbirths as well as intrapartum and neonatal deaths. Methods MRI was performed prior to autopsy in a consecutive cohort of perinatal deaths after full parental consent. Agreement between MRI and autopsy was calculated. The consent rate for both examinations was recorded separately, as well as the time between the perinatal death and the MRI. Main outcome measure Full agreement between MRI and autopsy. Results Of 58 cases, 26 parents consented to both examinations (45%). Autopsy showed 18 major malformations, of which 10 were detected with MRI. The positive predictive value of MRI was 80% (4/5) and the negative predictive value was 65% (13/20). Additional consent for MRI was given in eight cases (14%). In 84%, the MRI could be performed within 48 hours. Conclusions MRI is of value if autopsy is refused, but diagnostic accuracy is insufficient to recommend substitution of full autopsy. The acceptance rate of MRI only is better than that of autopsy. [source]

Modelling the potential impact of population-wide periconceptional folate/multivitamin supplementation on multiple births

BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 9 2001
Judith Lumley
Objective To develop a model of the impact of population-wide periconceptional folate supplementation on neural tube defects and twin births. Design A hypothetical cohort of 100,000 pregnancies ,20 weeks, plus terminations of pregnancy after prenatal diagnosis before 20 weeks. Methods Application of pooled data on the relative risks for neural tube defects and twins following periconceptional folate from meta-analysis of the randomised trials. Main outcome measures 1. Pregnancies with a neural tube defect (i.e. terminations of pregnancy, perinatal deaths, and surviving infants); 2. twin births (i.e. preterm births, perinatal deaths, postneonatal deaths, birth defects, cerebral palsy); 3. numbers needed to treat. Results The change in neural tube defects would be 75 fewer terminations (95% CI -47, -90), 30 fewer perinatal deaths (95% CI 18, -35), and 13 fewer surviving infants with a neural tube defect (95% CI ,8, -16). The change in twinning would be an additional 572 twin confinements (95% CI ,100, +1587), among whom there would be 63 very preterm twin confinements (95% CI ,11, +174), 54 perinatal and postneonatal deaths (95% CI ,9, +149), 48 surviving twins with a birth defect (95% CI ,8, +133), and nine with cerebral palsy (95% CI ,2, +26). The numbers needed to treat for the prevention of one pregnancy with a neural tube defect is 847, for the birth of one additional set of twins is 175, for the birth of one additional set of very preterm twins is 1587, and for the birth of an additional twin with any of the following outcomes (perinatal death, postneonatal death, survival with a birth defect, or survival with cerebral palsy) is 901. Conclusions Monitoring rates of neural tube defects and twinning is essential as supplementation or fortification with folate is implemented. [source]

Cerebral palsy and intrauterine growth in single births: European collaborative study

CHILD: CARE, HEALTH AND DEVELOPMENT, Issue 2 2004
Richard Reading
Background Cerebral palsy seems to be more common in term babies whose birthweight is low for their gestational age at delivery, but past analyses have been hampered by small datasets and Z -score calculation methods. Methods We compared data from 10 European registers for 4503 singleton children with cerebral palsy born between 1976 and 1990 with the number of births in each study population. Weight and gestation of these children were compared with reference standards for the normal spread of gestation and weight-for-gestational age at birth. Findings Babies of 32,42 weeks' gestation with a birthweight for gestational age below the 10th percentile (using fetal growth standards) were 4,6 times more likely to have cerebral palsy than were children in a reference band between the 25th and 75th percentiles. In children with a weight above the 97th percentile, the increased risk was smaller (from 1.6 to 3.1), but still significant. Those with a birthweight about 1 SD above average always had the lowest risk of cerebral palsy. A similar pattern was seen in those with unilateral or bilateral spasticity, as in those with a dyskinetic or ataxic disability. In babies of less than 32 weeks' gestation, the relation between weight and risk was less clear. Interpretation The risk of cerebral palsy, like the risk of perinatal death, is lowest in babies who are of above average weight-for-gestation at birth, but risk rises when weight is well above normal as well as when it is well below normal. Whether deviant growth is the cause or a consequence of the disability remains to be determined. [source]

Classification of perinatal deaths: Development of the Australian and New Zealand classifications

JOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 7 2004
A Chan
Abstract: Classifications of perinatal deaths have been undertaken for surveillance of causes of death, but also for auditing individual deaths to identify suboptimal care at any level, so that preventive strategies may be implemented. This paper describes the history and development of the paired obstetric and neonatal Perinatal Society of Australia and New Zealand (PSANZ) classifications in the context of other classifications. The PSANZ Perinatal Death Classification is based on obstetric antecedent factors that initiated the sequence of events leading to the death, and was developed largely from the Aberdeen and Whitfield classifications. The PSANZ Neonatal Death Classification is based on fetal and neonatal factors associated with the death. The classifications, accessible on the PSANZ website (http://www.psanz.org), have definitions and guidelines for use, a high level of agreement between classifiers, and are now being used in nearly all Australian states and New Zealand. [source]

Prospective community-based cluster census and case-control study of stillbirths and neonatal deaths in the West Bank and Gaza Strip

Uptake of the Perinatal Society of Australia and New Zealand perinatal mortality audit guideline

AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 2 2010
V. FLENADY
Background:, Deficiencies in investigation and audit of perinatal deaths result in loss of information thereby limiting strategies for future prevention. The Perinatal Society of Australia and New Zealand (PSANZ) developed a clinical practice guideline for perinatal mortality in 2004. Aims:, To determine the current use and views of the PSANZ guideline, focussing on the investigation and audit aspects of the guideline. Methods:, A telephone survey was conducted of lead midwives and doctors working in birth suites of maternity hospitals with over 1000 births per annum in Australia and New Zealand. Results:, Sixty-nine of the 78 eligible hospitals agreed to participate. A total of 133 clinicians were surveyed. Only 42% of clinicians surveyed were aware of the guideline; more midwives than doctors were aware (53 vs 28%). Of those, only 19% had received training in their use and 33% reported never having referred to them in practice. Implementation of even the key guideline recommendations varied. Seventy per cent of respondents reported regularly attending perinatal mortality audit meetings; midwives were less likely than doctors to attend (59 vs 81%). Almost half (45%) of those surveyed reported never receiving feedback from these meetings. The majority of clinicians surveyed agreed that all parents should be approached for consent to an autopsy examination of the baby; however, most (86%) reported the need for clinician training in counselling parents about autopsy. Conclusions:, Effective implementation programmes are urgently required to address suboptimal uptake of best practice guidelines on perinatal mortality audit in Australia and New Zealand. [source]

Systematic multidisciplinary approach to reporting perinatal mortality: Lessons from a five-year regional review

Reclassification of unexplained stillbirths using clinical practice guidelines

AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 3 2009
Elizabeth HEADLEY
Background: Twenty-eight per cent of stillbirths in Australia remain unexplained. A clinical practice guideline (CPG) produced by the Perinatal Society of Australia and New Zealand (PSANZ) Perinatal Mortality Special Interest Group is in use to assist clinicians in the investigation and audit of perinatal deaths. Aims: To describe in a tertiary hospital using the PSANZ stillbirth investigation guidelines: (i) the distribution and classification of stillbirths, and (ii) the compliance with suggested stillbirth core investigations. Methods: Retrospective cohort of all stillbirths delivered between November 2005 and March 2008. Stillbirths were defined as no sign of life on delivery at , 20 weeks gestation or 400 g birthweight if gestation is unknown. Data were collected via the hospital Perinatal Mortality Audit Committee (PMAC). Cause of death was classified by the PSANZ Perinatal Death Classification. Results: There were 86 stillbirths (rate 7.2 per 1000 births). The percentage of unexplained stillbirths was 34% and 13% before and after CPG investigations, respectively. Unexplained stillbirths had the highest compliance with the recommended investigations. The initial cause of death documented on the death certificate was changed by the PMAC in 19 cases. The investigations most likely to prompt a change in the cause of death classification were autopsy and placental pathology. Conclusions: The percentage of unexplained stillbirths is lower than the national average in a hospital using the Perinatal Mortality Audit Guidelines. However, overall compliance is low, suggesting a targeted approach to investigation is used by clinicians despite a policy that aims to be non-selective. Autopsy and placental examination are the most useful investigations in assisting formal classification of cause of death. [source]

Avoidable risk factors in perinatal deaths: A perinatal audit in South Australia

Human parvovirus B19 infection in pregnancy: should screening be offered to the low-risk population?

AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 4 2002
Wong Shell Fean
ABSTRACT Human parvovirus B19 infection during pregnancy can result in fetal hydrops and death. Intra-uterine transfusion in hydropic fetuses affected by the virus can reduce perinatal deaths. Up to 33% of women with this infection are asymptomatic. In view of the significant adverse outcomes, the role of routine screening among low-risk pregnant women is discussed. [source]

Maternal complications and pregnancy outcome in women with mechanical prosthetic heart valves treated with enoxaparin

BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 12 2009
C McLintock
Objective, To determine maternal and fetal outcomes in women with mechanical heart valves managed with therapeutic dose enoxaparin during pregnancy. Design, Retrospective audit. Setting, Hospital-based high-risk antenatal clinics. Population, Pregnant women with mechanical heart valves attending high-risk antenatal clinics, treated with enoxaparin (1 mg/kg twice daily) during pregnancy. Methods, Women with mechanical heart valves treated with enoxaparin at any stage during pregnancy (1997,2008) identified using a database of women with mechanical heart valves attending the high-risk clinics and a prospective database of women prescribed enoxaparin for any indication during pregnancy. Main outcome measures, Maternal outcomes included thromboembolic and haemorrhagic complications. Pregnancy and fetal outcomes included miscarriage, stillbirth, baby death and live birth, small-for-gestational-age infants, warfarin embryopathy and warfarin-related fetal loss. Results, Thirty-one women underwent 47 pregnancies. In 34 pregnancies (72.3%), anticoagulation was with predominantly enoxaparin and 13 (27.7%) pregnancies women received mainly warfarin, with enoxaparin given in the first trimester and/or peri-delivery. Seven (14.9%) thrombotic complications occurred, of which five (10.6%) were associated with enoxaparin treatment. Non-compliance or sub-therapeutic anti-Xa levels contributed in each case. Antenatal and postpartum haemorrhagic complications occurred in eight (17%) and 15 (32%) pregnancies respectively. Of 35 pregnancies continuing after 20 weeks' gestation, 96% (22/23) of women taking predominantly enoxaparin had a surviving infant compared with 75% (9/12) in women taking primarily warfarin. Four perinatal deaths occurred, three attributable to warfarin. Conclusions, Compliance with therapeutic dose enoxaparin and aspirin during pregnancy in women with mechanical heart valves is associated with a low risk of valve thrombosis and good fetal outcomes, but close monitoring is essential. [source]

World Health Organisation multicentre randomised trial of supplementation with vitamins C and E among pregnant women at high risk for pre-eclampsia in populations of low nutritional status from developing countries