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Neonatal Death (neonatal + death)
Selected AbstractsUtility of misoprostol for labor induction in severe pre-eclampsia and eclampsiaJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 5 2004Shamsun Nahar Abstract Objectives:, To determine the effectiveness and safety of misoprostol in severe pre-eclampsia and eclampsia patients with unripe cervix. Methods:, A prospective observational study was carried out in 135 severe pre-eclampsia and eclampsia patients who required termination of pregnancy at the Department of Obstetrics and Gynecology, Khulna Medical College Hospital, Khulna, Bangladesh during January 2002 to October 2003. Fifty micrograms of misoprostol was used every 4 h in cases of unripe cervix (Bishop score , 6) in severe pre-eclampsia and eclampsia patients. Maternal and perinatal outcome as well as any complications were recorded. Results:, In severe pre-eclampsia and eclampsia patients vaginal delivery occurred in 79.3 and 80.5% of cases, and cesarean section was performed in 20.6 and 19.4% of cases, respectively. The maximum required responsive dose was 50,150 µg. Oxytocin augmentation was required in 29.3 and 35% of cases, respectively. Induction to delivery time was median 8 h, interquartile ranges 4.2,8.2 h in the severe pre-eclampsia group, and median, 9 h,, interquartile, ranges, 6.8,12.5 h, in, the, eclampsia, group,, and, average, hospital, stay, was, 3.4 ± 1.8, and 3.7 ± 1.7 days, respectively. The only maternal complications were hyperstimulation which occurred in 6.8 and 5.1% of cases, respectively. Neonatal death occurred in five (11.3%) and eight cases (12.1%), respectively. Conclusion:, Intravaginal misoprostol is well tolerated and very effective for the induction of labor in severe pre-eclampsia and eclampsia patients with unripe cervix. [source] Neonatal death after hypoxic ischaemic encephalopathy: does a postmortem add to the final diagnoses?BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 7 2005Dawn E. Elder Background Case review after fatal perinatal asphyxia may have medicolegal implications. Accurate diagnosis of cause of death is therefore essential. Objective To determine consent rate and utility of autopsy after fatal grade III hypoxic ischaemic encephalopathy (HIE) presumed to be secondary to birth asphyxia. Design A retrospective clinical review from January 1995 to December 2002. Setting Regional tertiary referral neonatal unit, Wellington, New Zealand. Population Inclusion criteria were gestation ,37 weeks, resuscitation after delivery and clinical course of grade III HIE. Exclusions were a recognised major lethal malformation. Methods Review of clinical records including the autopsy report. Main outcome measures Consent for autopsy, change in diagnosis after autopsy. Results Twenty-three infants died during the time period with a major diagnosis of grade III HIE. Three did not meet inclusion criteria. Of the remaining 20, 11 were female. Median gestation at birth was 40 weeks (range 38,42 weeks) and median birth weight was 3568 g (range 2140,4475 g). In 8/17 of the infants for whom length and head measurements were available, the Ponderal Index suggested intrauterine growth retardation. The 16/20 infants had an autopsy. Four of these were Coroner's cases giving an autopsy rate of 80% with a rate by consent of 60%. In 10 (62.5%) infants, significant new information was added to the clinical diagnoses. Conclusions Neonatal HIE is a symptom rather than a final clinical diagnosis. A full autopsy is required to fully explore the reasons for fatal neonatal HIE and may provide information that is important medicolegally. [source] Neonatal cerebral ischaemia with elevated maternal and infant anticardiolipin antibodiesDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 6 2000Gabriel Chow MBBChir BSc DCH MRCPI MRCPCH A baby girl born by elective lower segment caesarean section was found to have left-sided focal seizures at 48 hours after birth. Her mother had previously had a neonatal death at 26 weeks' gestation and another child born at 32 weeks' gestation had a congenital right hemiplegia with a left middle cerebral artery infarct on CT scan. The mother had raised anticardiolipin IgG antibodies at the time of delivery of her second child, with no thrombotic symptoms. Therefore, during this pregnancy, she had been treated with low molecular weight heparin and aspirin. The baby's mother had raised IgG and IgM anticardiolipin antibodies and the baby had IgG anticardiolipin antibodies at the upper range of normal 4 days after delivery. The seizures were controlled with phenobarbitone and phenytoin. CT and MRI scans showed evidence of cerebral ischaemia. A repeat MRI scan at 4 months of age was normal, anticonvulsants were discontinued, and her latest neurological examination at 5 months was normal. [source] A survey of equine abortion, stillbirth and neonatal death in the UK from 1988 to 1997EQUINE VETERINARY JOURNAL, Issue 5 2003K. C. SMITH Summary Reasons for performing study: A detailed review of laboratory records for equine abortion is fundamental in establishing current disease trends and suggesting problems important for further research. Objectives: To review the causes of abortion and neonatal death in equine diagnostic submissions to the Animal Health Trust over a 10 year period. Methods: The diagnoses in 1252 equine fetuses and neonatal foals were reviewed and analysed into categories. Results: Problems associated with the umbilical cord, comprising umbilical cord torsion and the long cord/cervical pole ischaemia disorder, were the most common diagnoses (38.8%: 35.7% umbilical cord torsion and 3.1% long cord/cervical pole ischaemia disorder). Other noninfective causes of abortion or neonatal death included twinning (6.0%), intrapartum stillbirth (13.7%) and placentitis, associated with infection (9.8%). E. coli and Streptococcus zooepidemicus were the most common bacteria isolated. Neonatal infections not associated with placentitis accounted for 3.2% of incidents; and infections with EHV-1 or EHV-4 for 6.5%. Conclusions: Definitive diagnosis of equine abortion is possible in the majority of cases where the whole fetus and placenta are submitted for examination. Potential relevance: Given the high incidence of umbilical cord torsion and related problems as causes of abortion in UK broodmares, more research on factors determining umbilical cord length and risk of torsion is essential. [source] Bernard Soulier syndrome in pregnancy: a systematic reviewHAEMOPHILIA, Issue 4 2010P. PEITSIDIS Summary., Bernard Soulier syndrome (BSS) is a rare disorder of platelets, inherited mainly as an autosomal recessive trait. It is characterised by qualitative and quantitative defects of the platelet membrane glycoprotein (GP) Ib-IX-V complex. The main clinical characteristics are thrombocytopenia, prolonged bleeding time and the presence of giant platelets. Data on the clinical course and outcome of pregnancy in women with Bernard Soulier syndrome is scattered in individual case reports. In this paper, we performed a systematic review of literature and identified 16 relevant articles; all case reports that included 30 pregnancies among 18 women. Primary postpartum haemorrhage was reported in 10 (33%) and secondary in 12 (40%) of pregnancies, requiring blood transfusion in 15 pregnancies. Two women had an emergency obstetric hysterectomy. Alloimmune thrombocytopenia was reported in 6 neonates, with one intrauterine death and one neonatal death. Bernard Soulier syndrome in pregnancy is associated with a high risk of serious bleeding for the mother and the neonate. A multidisciplinary team approach and individualised management plan for such women are required to minimise these risks. An international registry is recommended to obtain further knowledge in managing women with this rare disorder. [source] Three-dimensional sonographic measurement of contralateral lung volume in fetuses with isolated congenital diaphragmatic hernia,JOURNAL OF CLINICAL ULTRASOUND, Issue 5 2008Rodrigo Ruano MD Abstract Purpose To use 3-dimensional sonography (3DUS) to measure contralateral lung volume and evaluate the potential of this measurement to predict neonatal outcome in isolated congenital diaphragmatic hernia (CDH). Methods Between January 2002 and December 2004, the contralateral lung volumes of 39 fetuses with isolated CDH were measured via 3DUS using rotational multiplanar imaging. The observed/expected contralateral fetal lung volume ratios (o/e-ContFLVR) were compared with the lung/head ratio (LHR), observed/expected total fetal lung volume ratio (o/e-TotFLVR), and postnatal outcome. Results Contralateral lung volumes are less reduced than total lung volumes in CDH. The bias and precision of 3DUS in estimating contralateral lung volumes were 0.99 cm3 and 1.11 cm3, respectively, with absolute limits of agreement ranging from ,1.19 cm3 to +3.17 cm3. The o/e-ContFLVR was significantly lower in neonatal death cases (median, 0.49 cm3; range, 0.22,0.99 cm3) than in survival cases (median, 0.58 cm3; range, 0.42,0.92 cm3 [p < 0.01]). Overall accuracy of the o/e-ContFLVR, o/e-TotFLVR, and LHR in predicting neonatal death were 67.7% (21/31), 80.7% (25/31), and 77.4% (24/31), respectively. Conclusion Although o/e-ContFLVR can be precisely measured with 3DUS and can be used to predict neonatal death in CDH, it is less accurate than LHR and o/e-TotFLVR for that purpose. © 2007 Wiley Periodicals, Inc. J Clin Ultrasound, 2008 [source] Malonyl CoA decarboxylase deficiency: C to T transition in intron 2 of the MCD geneJOURNAL OF NEUROSCIENCE RESEARCH, Issue 6 2001Sankar Surendran Abstract Malonyl CoA decarboxylase (MCD) is an enzyme involved in the metabolism of fatty acids synthesis. Based on reports of MCD deficiency, this enzyme is particular important in muscle and brain metabolism. Mutations in the MCD gene result in a deficiency of MCD activity, that lead to psychomotor retardation, cardiomyopathy and neonatal death. To date however, only a few patients have been reported with defects in MCD. We report here studies of a patient with MCD deficiency, who presented with hypotonia, cardiomyopathy and psychomotor retardation. DNA sequencing of MCD revealed a homozygous intronic mutation, specifically a ,5 C to T transition near the acceptor site for exon 3. RT-PCR amplification of exons 2 and 3 revealed that although mRNA from a normal control sample yielded one major DNA band, the mutant mRNA sample resulted in two distinct DNA fragments. Sequencing of the patient's two RT-PCR products revealed that the larger molecular weight fragments contained exons 2 and 3 as well as the intervening intronic sequence. The smaller size band from the patient contained the properly spliced exons, similar to the normal control. Western blotting analysis of the expressed protein showed only a faint band in the patient sample in contrast to a robust band in the control. In addition, the enzyme activity of the mutant protein was lower than that of the control protein. The data indicate that homozygous mutation in intron 2 disrupt normal splicing of the gene, leading to lower expression of the MCD protein and MCD deficiency. J. Neurosci. Res. 65:591,594, 2001. © 2001 Wiley-Liss, Inc. [source] Analysis of birth-related medical malpractice litigation cases in Japan: Review and discussion towards implementation of a no-fault compensation systemJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 4 2010Nana Uesugi Abstract Aim:, We examined birth-related malpractice civil litigation cases in Japan to clarify the actual status related to the implementation of an obstetrical no-fault compensation system in 2009. Material & Methods:, In this retrospective review, we analyzed legal and medical information from 64 cases with a delivery date after 1987 and a judgment date between April 1997 and March 2007. Results:, The malpractice claim was accepted in 44 cases and rejected in 20 cases. The period from the delivery to the judgment date was lengthy (90.1 months overall). The average amount of damages awarded was ¥97 810 000 for cases of cerebral palsy (CP). Preterm births and less than 2500 g infants represented a higher incidence rate in the rejected cases. There were 32 cases (50.0%) with CP, 18 (28.1%) with infant death, 10 (15.6%) with neonatal death, and 4 (6.3%) with fetal death. Twenty-three of 44 accepted cases (52.3%) and 11/20 rejected cases (55.0%) had a gestational age of more than 33 weeks at birth and weighed more than 2000 g. Forced deliveries were performed in 45/64 cases (70.3%), and augmentation/induction of labor was performed in 28/64 cases (43.8%). There were 13/16 (81.3%) accepted cases that underwent vacuum and/or forceps extraction after labor augmentation/induction. Conclusions:, More than half of our cases could be sufficient for a no-fault compensation system in Japan. Though the system is considered to have some problems that need to be solved, this finding suggests that many children and their families may benefit from the new system without having to file. [source] Outcomes of multifetal pregnanciesJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 1 2007Ounjai Kor-anantakul Abstract Aim:, To determine the outcomes of multifetal pregnancies and to compare maternal and neonatal complications between spontaneously conceived and assisted reproductive therapy. Methods:, A retrospective analysis was conducted of the information from medical records relating to all multifetal pregnancies. The outcomes were analyzed and used for a comparison between spontaneous and assisted multifetal pregnancies. Results:, There were 387 multifetal pregnancies during the study period, which was 1.3% of all the deliveries; 334 cases (86.3%) were spontaneous conceptions and 53 cases (13.7%) were the result of assisted reproductive therapy. Higher-order fetuses (,3) represented 8% of all multifetal pregnancies, 13% in the spontaneous group and 87% in the assisted group. The overall cesarean delivery rate was 73.9%. The assisted reproductive therapy group had a cesarean rate of 90.6% compared with 71.3% in the spontaneous group (P = 0.008). The assisted multifetal pregnancy group had more preterm labors and a longer maternal hospital stay than the spontaneous group. One maternal death occurred in the assisted group. The main causes of early neonatal death were prematurity, infection and congenital malformation. The newborns in the assisted group had more complications than the spontaneous group; most notable were respiratory distress syndrome, newborn intensive care admission, infection and longer hospital stay (6 days vs 15 days, P < 0.001). More complications occurred in higher-order fetuses than with twins. Conclusions:, Assisted multifetal pregnancies were more likely to be delivered by cesarean section and had a higher rate of higher-order fetuses, preterm birth and neonatal prematurity-related complications with a longer hospital stay in both mothers and newborns, than spontaneous multifetal pregnancies. [source] Couple distress after sudden infant or perinatal death: A 30-month follow upJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 4 2002JC 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] Alveolar capillary dysplasia with antenatal anomalies mimicking trisomy 21JOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 1 2001J. McGaughran Abstract: Alveolar capillary dysplasia (ACD) has been described in conjunction with a number of congenital abnormalities. The case reported here was noted in utero to have duodenal atresia and a partial atrioventricular canal defect and a provisional diagnosis of trisomy 21 was considered. A fetal blood sample showed a normal karyotype. The diagnosis of ACD was made at post-mortem following a neonatal death on the tenth day. This case further highlights the range of congenital abnormalities that may be present in cases of ACD that may mimic other conditions, including trisomy 21, on antenatal scan. However, the absence of congenital anomalies, even in the same family, would not exclude the diagnosis of ACD. [source] Expression of insulin-like growth factors systems in cloned cattle dead within hours after birthMOLECULAR REPRODUCTION & DEVELOPMENT, Issue 4 2007Shijie Li Abstract Cloning by somatic nuclear transfer is an inefficient process in which many of the cloned animals die shortly after birth and display organ abnormalities. In an effort to determine the possible roles IGFs played in neonatal death and organ abnormalities, we have examined expression patterns of eight genes in insulin-like growth factor (IGF) systems (IGF1, IGF2, IGF1R, IGF2R, IGFBP-1, IGFBP-2, IGFBP-3, and IGFBP-4) in six organs (heart, liver, spleen, lung, kidney, and brain) of both neonatal death cloned bovines (n,=,9) and normal control calves (n,=,3) produced by artificial insemination (AI) using real-time quantitative RT-PCR. The effect of the age of the fibroblast donor cell on the gene expression profiles was also investigated. Aberrant expressions of six genes (IGF2, IGF1R, IGF2R, IGFBP-2, IGFBP-3, and IGFBP-4) were found in some studied tissues, but the expression of two genes (IGF1 and IGFBP-1) had similar levels with the normal controls. For the studied genes, kidney was the organ that was most affected (five genes) by gene downregulation, whereas spleen was the organ that was not affected. The two upregulation genes were in brain, but both of downregulation and upregulation were found in the heart, liver, and lung. The expression of three genes (IGF2R, IGFBP-4, and IGF2) in some tissues showed significant differences between AF cell-derived and FF cell-derived clones. Our results suggest that aberrations in gene expression within IGF systems were found in most cloned bovine tissues of neonatal death. Because IGF systems play an important role in embryo development and organogenesis, the aberrant transcription patterns detected in these clones may contribute to the defects of organs reported in neonatal death of clones. Mol. Reprod. Dev. 74: 397,402, 2007. © 2006 Wiley-Liss, Inc. [source] Prospective community-based cluster census and case-control study of stillbirths and neonatal deaths in the West Bank and Gaza StripPAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 4 2008Henry 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] Excessive volume expansion and neonatal death in preterm infants born at 27,28 weeks gestationPAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 2 2003Andrew K. Ewer Summary Volume expansion is used commonly in preterm infants to treat presumed hypovolaemia. However, the amount that should be given is uncertain. We present data that were obtained from anonymised regional case notes of Project 27/28, a national case,controlled study run by the Confidential Enquiry into Stillbirths and Deaths in Infancy. Various clinical parameters were analysed, including the volume expansion administered during the first 48 h of life. All deaths in the first year of the study in the West Midlands (cases, n = 22) and matched regional controls (survivors, n = 29) were included. The primary outcome was death within 28 days. Sixteen of the 22 deaths were considered ,not inevitable' on the basis of the neonates' condition at birth. These newborns received on average more than twice the volume expansion compared with controls in the first 48 h of life (38.2 vs. 18.2 mL/kg, P = 0.007). There were no significant differences between the groups in lowest blood pressure or base deficit within the first 12 h of life. Newborns who received , 30 mL/kg volume expansion in the first 48 h of life were more likely to die than those who received < 30 mL/kg (OR 4.5 [95% CI 1.2, 17.2]). Our data suggest that administration of , 30 mL/kg volume expansion is associated with increased mortality in neonates of 27,28 weeks' gestation. Unless there is clear evidence of hypovolaemia, clinicians should exercise caution when prescribing volume expansion. [source] Minimally invasive fetal postmortem examination using magnetic resonance imaging and computerised tomography: current evidence and practical issuesPRENATAL DIAGNOSIS, Issue 8 2010S. Thayyil Abstract For a variety of reasons, acceptance of traditional postmortem examination following foetal or neonatal death has declined significantly in recent years in the UK. Here, we review the case for the development of less invasive autopsy using combined investigations including imaging techniques, in particular, magnetic resonance imaging and computerised tomography. Copyright © 2010 John Wiley & Sons, Ltd. [source] Perinatal imaging findings of inherited Sotos syndromePRENATAL DIAGNOSIS, Issue 10 2002Chih-Ping Chen Abstract Objectives Although most cases of Sotos syndrome are sporadic, familial cases have been described. In familial cases, the most likely mode of inheritance is autosomal dominant with variable expressivity. We present the perinatal imaging findings of an inherited case. Case This was the second pregnancy of a 32-year-old woman with Sotos syndrome. She had given birth to her first child with macrocephaly, ventriculomegaly, macrocisterna magna and neonatal death at 28 weeks' gestation. During this pregnancy, prenatal ultrasonography at 18 weeks' gestation showed only mild dilatation of lateral ventricles. The pregnancy was uneventful until 31 weeks' gestation when fetal macrocephaly, right hydronephrosis, and polyhydramnios began to develop. At 33 weeks' gestation, dilatation of the third ventricle and fetal overgrowth were obvious. At 34 weeks' gestation, macrodolichocephaly, hypoplasia of the corpus callosum, enlargement of the lateral ventricles with prominent occipital horns, and macrocisterna magna were noted. At 36 weeks' gestation, a male baby was delivered with macrodolichocephaly, frontal bossing and a facial gestalt of Sotos syndrome. Birth weight was 3822 g, length 55 cm, and occipitofrontal head circumference 41 cm (all > 97th centile). The magnetic resonance imaging (MRI) scans demonstrated enlargement of the lateral ventricles, the trigones, and the occipital horns, hypoplasia of the corpus callosum, a persistent cavum septum pellucidum and cavum vergae, and macrocisterna magna. Conclusions Fetuses at risk for Sotos syndrome may present abnormal sonographic findings of the brain and the skull in association with overgrowth, unilateral hydronephrosis and polyhydramnios in the third trimester. Perinatal MRI studies aid in confirmation of the diagnosis. Copyright © 2002 John Wiley & Sons, Ltd. [source] A genome wide association study for QTL affecting direct and maternal effects of stillbirth and dystocia in cattleANIMAL GENETICS, Issue 3 2010H. G. Olsen Summary Dystocia and stillbirth are significant causes of female and neonatal death in many species and there is evidence for a genetic component to both traits. Identifying causal mutations affecting these traits through genome wide association studies could reveal the genetic pathways involved and will be a step towards targeted interventions. Norwegian Red cattle are an ideal model breed for such studies as very large numbers of records are available. We conducted a genome wide association study for direct and maternal effects of dystocia and stillbirth using almost 1 million records of these traits. Genotyping costs were minimized by genotyping the sires of the recorded cows, and using daughter averages as phenotypes. A dense marker map containing 17 343 single nucleotide polymorphisms covering all autosomal chromosomes was utilized. The genotyped sires were assigned to one of two groups in an attempt to ensure independence between the groups. Associations were only considered validated if they occurred in both groups. Strong associations were found and validated on chromosomes 4, 5, 6, 9, 12, 20, 22 and 28. The QTL region on chromosome 6 was refined using LDLA analysis. The results showed that this chromosome most probably contains two QTL for direct effect on dystocia and one for direct effect on stillbirth. Several candidate genes may be identified close to these QTL. Of these, a cluster of genes expected to affect bone and cartilage formation (i.e. SPP1, IBSP and MEPE) are of particular interest and we suggest that these genes are screened in candidate gene studies for dystocia and stillbirth in cattle as well as other species. [source] Death losses due to stillbirth, neonatal death and diseases in cloned cattle derived from somatic cell nuclear transfer and their progeny: a result of nationwide survey in JapanANIMAL SCIENCE JOURNAL, Issue 3 2009Shinya WATANABE ABSTRACT To obtain the data concerning death losses due to stillbirth, neonatal death and diseases in cloned cattle derived from somatic cell nuclear transfer (SCNT) and their progeny produced by Japanese institutions, a nationwide survey was carried out in July-August, 2006. As a result, lifetime data concerning 482 SCNT cattle (97.5% of cattle produced in the country at that time) and 202 progeny of SCNT cattle were accumulated and the death loss of these cattle was analyzed. Although 1/3 of delivered SCNT calves died during the perinatal period due to stillbirth and neonatal death, incidence of death loss due to diseases in SCNT cattle surviving more than 200 days after birth seems to be the same as these in conventionally bred cattle. In contrast, progeny of SCNT cattle showed the same level in death loss as observed in conventionally bred cattle throughout their lifetime. These results suggest that robust health would be expected in SCNT cattle surviving to adulthood and their progeny. [source] Clinical-Scientific Notes: Successful pregnancy outcome with the use of antenatal high-dose intravenous immunoglobulin following previous neonatal death associated with neonatal haemochromatosisAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 4 2010Michael C. NICHOLL No abstract is available for this article. [source] A randomised controlled trial of two instruments for vacuum-assisted delivery (Vacca Re-Usable OmniCup and the Bird anterior and posterior cups) to compare failure rates, safety and use effectivenessAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 3 2010Glen D.L. MOLA Background:, Most previous trials of vacuum-assisted delivery have been in settings with high rates of instrumental vaginal delivery (8,12%) and high rates of failure to deliver with the intended instrument (20,30%). Over the past 20 years, vacuum-assisted delivery rates at the Port Moresby General Hospital have been 3,4% with failure rates of <3%. Objective:, The objective is to compare the failure rates of two vacuum extractor instruments, the Vacca Re-Usable Omnicup and the Bird Vacuum delivery system (anterior and posterior cups). Setting:, Port Moresby General national referral and teaching Hospital (PMGH), Papua New Guinea. Population:, Two hundred consecutive women requiring assisted delivery, June,December, 2007. Methods:, When a woman required an assisted delivery, she was randomised into either the Vacca Re-Usable Omnicup (Clinical Innovations Inc.) or Bird anterior or posterior metal cup (depending upon the position of the vertex). One hundred women were randomised to each vacuum device. Statistical analysis was on ,an intention-to-treat' basis. Main outcome measures:, The main outcome measure was the successful completion of the delivery with the allocated instrument. Secondary outcomes were maternal trauma (episiotomy and trauma to the maternal genital tract), significant scalp trauma (sub-galeal haemorrhage or serious abrasion) and fetal and neonatal outcomes (Apgar score less than seven at 5 minutes, days spent in the Special Care Nursery and neonatal death). Results:, Failure rates for both Omnicup (2/100) and Bird metal cups (6/100) were not statistically different (RR 1.05, 95% CI 0.99,1.12; P = 0.17). Rates of maternal trauma and fetal scalp trauma were similar in both groups. Conclusion:, Both the Vacca re-useable Omnicup and the Bird metal cups are very effective instruments to achieve successful assisted delivery and equally so. Failures and problems were associated with not applying the vacuum cup to the flexion point on the fetal scalp and the mechanical faults with vacuum equipment devices. [source] Immediate outcome of twin,twin transfusion syndrome following selective laser photocoagulation of communicating vessels at the NSW Fetal Therapy CentreAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 2 2010N. MERIKI Objective:, To audit the outcome for laser photocoagulation for twin,twin transfusion syndrome (TTTS) as managed by the New South Wales Fetal Therapy Centre (NSW FTC). Methods: A retrospective cohort study. Outcome data were reviewed for referrals between June 2003 and June 2008. The outcome measures included the severity of TTTS at presentation, delivery details (gestational age at delivery, birth weight and Apgar score at 5 min) and perinatal outcome (spontaneous miscarriage, premature rupture of membranes, intrauterine death, placental abruption and neonatal death). Results: Seventy-nine patients were treated with laser therapy for stage I,IV TTTS (median stage III). Median gestational age at treatment was 20 weeks (range 16,25). Median gestational age at delivery was 32 weeks (range 24,40). Survival of at least one baby in this study was 90.7% (88.9% for anterior and 92.1% for posterior placenta), and of both babies was 60.0%. Median birth weight was 1788 g (range 490,3695). Median Apgar score was nine at 5 min. Three women required repeat laser treatment for persistent TTTS. Conclusions: Selective laser photocoagulation of communicating vessels remains the treatment of choice for TTTS. Referrals to the NSW FTC have increased from five cases in the last half of 2003, to 18 cases in the first half of 2008. Local outcome figures at least equal any in the published international literature and support a continued policy of centralised care in Australia. A two-year follow-up study on neonatal outcome for survivors is underway. [source] Systematic multidisciplinary approach to reporting perinatal mortality: Lessons from a five-year regional reviewAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 5 2009Alison 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] Substance use during pregnancy: risk factors and obstetric and perinatal outcomes in South AustraliaAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 3 2005Robyn KENNARE Abstract Objective: To determine the prevalence of self-reported substance use during pregnancy in South Australia, the characteristics of substance users, their obstetric outcomes and the perinatal outcomes of their babies. Methods: Multivariable logistic regression with STATA statistical software was undertaken using the South Australian perinatal data collection 1998,2002. An audit was conducted on every fifth case coded as substance use to identify the actual substances used. Results: Substance use was reported by women in 707 of 89 080 confinements (0.8%). Marijuana (38.9%), methadone (29.9%), amphetamines (14.6%) and heroin (12.5%) were most commonly reported, with polydrug use among 18.8% of the women audited. Substance users were more likely than non-users to be smokers, to have a psychiatric condition, to be single, indigenous, of lower socio-economic status and living in the metropolitan area. The outcome models had poor predictive powers. Substance use was associated with increased risks for placental abruption (OR 2.53) and antepartum haemorrhage from other causes (OR 1.41). The exposed babies had increased risks for preterm birth (OR 2.63), small for gestational age (OR 1.79), congenital abnormalities (1.52), nursery stays longer than 7 days (OR 4.07), stillbirth (OR 2.54) and neonatal death (OR 2.92). Conclusions: Substance use in pregnancy is associated with increased risks for antepartum haemorrhage and poor perinatal outcomes. However, only a small amount of the variance in outcomes can be explained by the substance use alone. Recent initiatives to improve identification and support of women exposed to adverse health, psychosocial and lifestyle factors will need evaluation. [source] Perinatal mortality and morbidity in a nationwide cohort of 529 688 low-risk planned home and hospital birthsBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 9 2009A De Jonge Objective, To compare perinatal mortality and severe perinatal morbidity between planned home and planned hospital births, among low-risk women who started their labour in primary care. Design, A nationwide cohort study. Setting, The entire Netherlands. Population, A total of 529 688 low-risk women who were in primary midwife-led care at the onset of labour. Of these, 321 307 (60.7%) intended to give birth at home, 163 261 (30.8%) planned to give birth in hospital and for 45 120 (8.5%), the intended place of birth was unknown. Methods, Analysis of national perinatal and neonatal registration data, over a period of 7 years. Logistic regression analysis was used to control for differences in baseline characteristics. Main outcome measures, Intrapartum death, intrapartum and neonatal death within 24 hours after birth, intrapartum and neonatal death within 7 days and neonatal admission to an intensive care unit. Results, No significant differences were found between planned home and planned hospital birth (adjusted relative risks and 95% confidence intervals: intrapartum death 0.97 (0.69 to 1.37), intrapartum death and neonatal death during the first 24 hours 1.02 (0.77 to 1.36), intrapartum death and neonatal death up to 7 days 1.00 (0.78 to 1.27), admission to neonatal intensive care unit 1.00 (0.86 to 1.16). Conclusions, This study shows that planning a home birth does not increase the risks of perinatal mortality and severe perinatal morbidity among low-risk women, provided the maternity care system facilitates this choice through the availability of well-trained midwives and through a good transportation and referral system. [source] Influence of mode of delivery on neonatal mortality in the second twin, at and before termBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 12 2008A Herbst Design, To study the association between mode of delivery and neonatal mortality in second twins. To study the association between caesarean delivery and mortality with minimum bias of the indication for the operation, we wanted to compare the outcome of second twins delivered by caesarean due to breech presentation of the sibling with vaginally delivered second twins in uncomplicated pregnancies. Setting, Sweden, 1980,2004 Population, Twins born during 1980,2004 were identified from the Swedish Medical Birth Registry. Twin pairs delivered by caesarean due to breech presentation of the first twin, and vaginally delivered twins with the first twin in cephalic presentation were included. Pregnancies with antepartum complications were excluded. Methods, Odds ratios and 95% CI were calculated using multiple logistic regression analyses, adjusting for year of birth, maternal age, parity and gestational age. Main outcome measures, Neonatal mortality. Results, Compared with second-born twins delivered vaginally, second-born twins delivered by caesarean (for breech presentation of the sibling) had a lower risk of neonatal death (adjusted OR 0.40; 95% CI 0.19,0.83). The decreased risk after caesarean delivery was significant for births before 34 weeks (2.1 versus 9.0%; adjusted OR 0.40; 95% CI 0.17,0.95). After 34 weeks, neonatal mortality was low in both groups (0.1 and 0.2%, respectively), and the difference was not statistically significant (adjusted OR 0.42; 95% CI 0.10,1.79). Conclusions, Neonatal mortality is lower for the second twin after caesarean delivery at birth before 34 weeks. At term, mortality is low irrespective of delivery mode. [source] Severe asphyxia due to delivery-related malpractice in Sweden 1990,2005BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 3 2008S Berglund Objective, To describe possible causes of delivery-related severe asphyxia due to malpractice. Design and setting, A nationwide descriptive study in Sweden. Population, All women asking for financial compensation because of suspected medical malpractice in connection with childbirth during 1990,2005. Method, We included infants with a gestational age of ,33 completed gestational weeks, a planned vaginal onset of delivery, reactive cardiotocography at admission for labour and severe asphyxia-related outcomes presumably due to malpractice. As asphyxia-related outcomes, we included cases of neonatal death and infants with diagnosed encephalopathy before the age of 28 days. Main outcome measure, Severe asphyxia due to malpractice during labour. Results, A total of 472 case records were scrutinised. One hundred and seventy-seven infants were considered to suffer from severe asphyxia due to malpractice around labour. The most common events of malpractice in connection with delivery were neglecting to supervise fetal wellbeing in 173 cases (98%), neglecting signs of fetal asphyxia in 126 cases (71%), including incautious use of oxytocin in 126 cases (71%) and choosing a nonoptimal mode of delivery in 92 cases (52%). Conclusion, There is a great need and a challenge to improve cooperation and to create security barriers within our labour units. The most common cause of malpractice is that stated guidelines for fetal surveillance are not followed. Midwives and obstetricians need to improve their shared understanding of how to act in cases of imminent fetal asphyxia and how to choose a timely and optimal mode of delivery. [source] Pregnancy-induced hypertension and infant mortality: roles of birthweight centiles and gestational ageBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 1 2007XK Chen Objective, To assess the effect of pregnancy-induced hypertension (PIH) on infant mortality in different birthweight centiles (small for gestational age [SGA], appropriate for gestational age [AGA], and large for gestational age [LGA]) and gestational ages (early preterm, late preterm, and full term). Design, Retrospective cohort study. Setting, Linked birth and infant death data set of USA between 1995 and 2000. Population, A total of 17 464 560 eligible liveborn singleton births delivered after 20th gestational week. Methods, Multivariate logistic regression models were applied to evaluate the association between PIH and infant mortality, with adjustment of potential confounders stratified by birthweight centiles and gestational age. Main outcome measure, Infant death (0,364 days) and its three components: early neonatal death (0,6 days), late neonatal death (7,27 days), and postneonatal death (28,364 days). Results, PIH was associated with decreased risks of infant mortality, early neonatal mortality, and late neonatal mortality in both preterm and term SGA births, and PIH was associated with lower postneonatal mortality in preterm SGA births. PIH was associated with decreased risks of infant mortality, early neonatal mortality, late neonatal mortality and postneonatal mortality in preterm AGA births. Decreased risk of infant mortality and early neonatal mortality was associated with PIH in early preterm LGA births. Conclusions, The association between PIH and infant mortality varies depending on different birthweight centiles, gestational age, and age at death. PIH is associated with a decreased risk of infant mortality in SGA births, preterm AGA births, and early preterm LGA births. [source] Possible association between amniotic fluid micro-organism infection and microflora in the mouthBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 5 2002Caroline Bearfield Objective To determine whether oral bacteria are found in the amniotic cavity. Design Laboratory based analysis of clinical samples. Setting Royal London Hospital, Whitechapel. Population Forty-eight women attending for elective caesarean section. Methods Dental plaque, a high vaginal swab, amniotic fluid and chorioamnion tissue were taken from women with intact membranes. Main outcome measures Samples were investigated using culture and microscopy for the presence of micro-organisms. Amniotic fluid was analysed by polymerase chain reaction (PCR) for the presence of the ubiquitous 16S rRNA gene specific to most eubacteria. Samples were analysed using PCR genus and species specific primers directed to bacterial taxa found as part of the normal oral microflora (Streptococcus spp. and Fusobacterium nucleatum). Levels of prostaglandin E2 and cytokines were measured in amniotic fluid. Results Amniotic fluid was positive for universal bacteria PCR, Streptococcus spp. PCR and F. nucleatum PCR in 34/48, 20/48 and 7/48 of cases, respectively. Streptococcus spp. and F. nucleatum were cultured from the dental plaque, vagina and amniotic fluid of 48/48, 14/48, 0/48 and 29/48, 6/48, 0/48 subjects, respectively. A significant association was found between detection of microbial DNA (universal and F. nucletum) and complications in previous pregnancies including miscarriage, intrauterine death, neonatal death, preterm delivery and premature rupture of membranes (P < 0.05 and P < 0.01, respectively). Prostaglandin E2 and cytokine levels, with the exception of IL-1,, were not significantly different between women with and without evidence of infection. Conclusions The results indicate that Streptococcus spp. and F. nucleatum in the amniotic fluid may have an oral origin. [source] Optimal birth weight percentile cut-offs in defining small- or large-for-gestational-ageACTA PAEDIATRICA, Issue 4 2010Abstract Aims:, It remains questionable what birth weight for gestational age percentile cut-offs should be used in defining clinically important poor or excessive foetal growth. We aimed to evaluate the optimal birth weight percentile cut-offs for defining small- or large-for-gestational-age (SGA or LGA). Methods:, In a birth cohort-based analysis of 17 979 120 non-malformation singleton live births, U.S. 1995,2001, we assessed the optimal birth weight percentile cut-offs for defining SGA and LGA. The 25th,75th percentile group served as the reference. Primary outcomes are the risk ratios (RR) of neonatal death and low 5-min Apgar score (<4) comparing SGA or LGA versus the reference group. More than 2-fold risk elevations were considered clinically significant. Results:, The 15th birth weight cut-off already identified SGA infants at more than 2-fold risk of neonatal death at pre-term, term or post-term, except for extremely pre-term births <28 weeks (continuous risk reductions over increasing birth weight percentiles). LGA was associated with a reduced risk of low 5-min Apgar score at pre-term, but an elevated risk at term and post-term. The 97th cut-off identified LGA infants at 2-fold risk of low 5-min Apgar at term. Conclusion:, The commonly used 10th and 90th birth weight percentile cut-offs for defining SGA and LGA respectively seem largely arbitrary. The 15th and 97th percentiles may be the optimal cut-offs to define SGA and LGA respectively. [source] Short-term outcome after active perinatal management at 23,25 weeks of gestation.ACTA PAEDIATRICA, Issue 7 2004A study from two Swedish tertiary care centres. Aims: To provide descriptive data on women who delivered at 23,25 wk of gestation, and to relate foetal and neonatal outcomes to maternal factors, obstetric management and the principal reasons for preterm birth. Methods: Medical records of all women who had delivered in two tertiary care centres in 1992,1998 were reviewed. At the two centres, policies of active perinatal and neonatal management were universally applied. Logistic regression models were used to identify prenatal factors associated with survival. Results: Of 197 women who delivered at 23,25 wk, 65% had experienced a previous miscarriage, 15% a previous stillbirth and 12% a neonatal death. The current pregnancy was the result of artificial reproduction in 13% of the women. In 71%, the pregnancy was complicated either by preeclampsia, chorioamnionitis, placental abruption or premature rupture of membranes. Antenatal steroids were given in 63%. Delivery was by caesarean section in 47%. The reasons for preterm birth were idiopathic preterm labour in 36%, premature rupture of membranes in 41% and physician-indicated deliveries in 23% of the mothers. Demographic details, use of antenatal steroids, caesarean section delivery and birthweight differed between mothers depending on the reason for preterm delivery. Of 224 infants, 5% were stillbirths and 63% survived to discharge. On multivariate logistic regression analysis comprising prenatally known variables, reasons for preterm birth were not associated with survival. Advanced gestational duration (OR: 2.43 per wk; 95% CI: 1.59,3.74), administration of any antenatal steroids (OR: 2.21; 95% CI: 1.14,4.28) and intrauterine referral from a peripheral hospital (OR: 2.93; 95% CI: 1.5,5.73) were associated with survival. Conclusions: Women who deliver at 23,25 wk comprise a risk group characterized by a high risk of reproductive failure and pregnancy complications. Survival rates were similar regardless of the reason for preterm birth. Policies of active perinatal management virtually eliminated intrapartum stillbirths. [source] | ||||||||||||||||||||||||||||