Abstract
Background :No universal demarcation of gestational age distinguishes miscarriage and stillbirth or extreme preterm birth (exPTB). This study provides a synopsis of outcome between 22 to <28 weeks gestation from a low resource setting. Methods :A retrospective record review of a population on the Thailand-Myanmar border was conducted. Outcomes were classified as miscarriage, late expulsion of products between 22 to < 28 weeks gestation with evidence of non-viability (mostly ultrasound absent fetal heart beat) prior to 22 weeks; or exPTB (stillbirth/live born) between 22 to < 28 weeks gestation when the fetus was viable at ≥22 weeks. Termination of pregnancy and gestational trophoblastic disease were excluded. Results :From 1995-2015, 80.9% (50,046/ 61,829) of registered women had a known pregnancy outcome, of whom 99.8% (49,931) had a known gestational age. Delivery between 22 to <28 weeks gestation included 0.9% (472/49,931) of pregnancies after removing 18 cases (3.8%) who met an exclusion criteria. Most pregnancies had an ultrasound: 72.5% (n=329/454); 43.6% (n=197) were classified as miscarriage and 56.4% (n=257) exPTB. Individual record review of miscarriages estimated that fetal death had occurred at a median of 16 weeks, despite late expulsion between 22 to <28 weeks. With available data (n=252, 5 missing) the proportion of stillbirth was 47.6% (n=120), congenital abnormality 10.5% (24/228, 29 missing) and neonatal death was 98.5% (128/131, 1 missing). Introduction of ultrasound was associated with a 2-times higher odds of classification of outcome as exPTB rather than miscarriage. Conclusion :In this low resource setting few (<1%) pregnancy outcomes occurred in the 22 to <28 weeks gestational window; four in ten were miscarriage (late expulsion) and neonatal mortality approached 100%. In the scale-up to preventable newborns deaths (at least initially) greater benefits will be obtained by focusing on the viable newborns of ≥ 28 weeks gestation.
Highlights
To determine progress towards the Sustainable Developmental Goal (SDG) 3.2 “by 2030, to end preventable deaths of newborns and children under 5 years of age”, standardized data collection is critical[1,2,3]
Is a stillborn 1000 g fetus with accurately determined gestation born at 27+2 weeks+days, a late fetal death because of the birth weight or an early fetal death because of the gestation? For organizations that utilize the WHO definition of stillbirth recommended for global comparison i.e.: “a baby born with no signs of life at or after 28 weeks gestation”[10] confusion arises with live newborns before 28 weeks
The window of gestation from 22 to
Summary
To determine progress towards the Sustainable Developmental Goal (SDG) 3.2 “by 2030, to end preventable deaths of newborns and children under 5 years of age”, standardized data collection is critical[1,2,3]. The International Classification of Diseases, provides a graded definition of miscarriage (pregnancy loss before 22 completed weeks gestation); and stillbirth (expulsion of a fetus with no signs of life) classified as early fetal death (of a fetus weighing 500 g or more, or aged 22 weeks or more, or with a body length of 25 cm or more); late fetal death (of a fetus of 1000 g or more, or aged 28 weeks or more, or with a body length of 35 cm or more)[9]. With available data (n=252, 5 missing) the proportion of stillbirth was 47.6% (n=120), congenital
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