Cases Of Perinatal Death Research Articles

A Rare Case of Neonatal Death Due to a Cranial Vault Fracture Following the Use of Obstetric Vacuum Extractor and Review of Literature.

In the course of childbirth, if complications arise during the expulsion of the fetus, instruments can be employed to facilitate delivery. The vacuum extractor, or ventouse, is considered a relatively safe tool associated with a low rate of complications and mortality. However, it is crucial that the instrument be applied in the correct position and that the pulling force is not excessive to minimize damage to the fetal cranial structures. Fractures of the cranial vault following the application of obstetric vacuum extraction are very rare events.This paper presents a case of perinatal death due to cranial vault fracture and subgaleal hematoma following vacuum extractor application. Only through postmortem examination was it possible to identify incorrect positioning of the ventouse, which was lateralized compared to the recommended position. The misplacement of the device led to an imbalance of forces, causing the cranial vault fracture that led to the infant's demise.A thorough postmortem examination is essential in cases of perinatal death resulting from operative delivery to ascertain the cause of death and reconstruct the dynamics of events during childbirth. In particular, the examination of injuries on the decedent neonate may reveal improper positioning of the instrument.

Uterine rupture: Epidemiology, Risk Factors and Maternal-Fetal Prognosis at the Bougouni Reference Health Center

Introduction: the objective of this study was to study the epidemiological aspects, risk factors and maternal-fetal prognosis of uterine rupture in the Gynecology-Obstetrics Unit of the CSRéf of Bougouni Methodology: We carried out a case-control study from January 1 to December 31, 2019 in the Gynecology-Obstetrics Unit of the Bougouni Reference Health Center. All patients treated in the uterine rupture department were included and two controls (delivery without rupture) for one case (uterine rupture). The data were entered and analyzed on SPSS version 21 software. The significance threshold has been set at 5%. The association between 2 qualitative variables was studied by the Chi². Results: At the end of our study, we had recorded 43 cases of uterine rupture out of a total of 1161 deliveries, i.e. a frequency of 3.7%. The average age of the cases: 30.77 ± 2 years with extremes of 18 and 40 years compared to 26.01 ± 1 years for controls with extremes of 14 and 42 years. Ninety-five percent of our patients for the cases were out of school compared to 86% for the controls, 97% were housewives compared to 82% for the controls. Risk factors were dominated: caesarean section scar (p=0.038); OR=2.99, non-follow-up of pregnancy (p=0.002) and residence in a rural area (p=0.000) and intergenerational interval ≤ 2 years (Chi-square = 9.1735; p = 0.002). The maternal-fetal prognosis is reserved with 1 case of maternal death (2.3%) and 28 cases of perinatal death (65.1%). Keywords: Uterine rupture, Risk factors, maternal-fetal prognosis, case-control study.

Clinical Characteristics and Causes of Perinatal Death Among Women Who Delivered at SekouToure Regional Referral Hospital, Mwanza Region, Northwestern Tanzania

<i>Background</i>: Perinatal deaths and neonatal deaths are major public health concern worldwide. They are unexpected tragedy which brings bad experience to the pregnant mothers and the families in general. Occurrences of these deaths may be used to evaluate the quality of obstetric care given to pregnant women in the hospital. They shows good quality of obstetric care when they are low in number. Therefore, more efforts must be directed in preventing these deaths. <i>Methods</i>: This was a one-year retrospective descriptive hospital based study conducted in one of the tertiary regional referral hospital. Women who had perinatal deaths between the studied periods and meet the inclusion criteria were included. <i>Results</i>: There were 7336 deliveries in the study, 81.1% (n =5953) had vagina deliveries and 18.9% (n=1383) had Caesarean section. Total of 169 cases of perinatal deaths identified, making a rate of perinatal deaths of 23 cases per 1000 deliveries (2.3%). Among perinatal death 40% (n=67) were early neonatal deaths and there was an identified association between referral from lower health facilities with early neonatal deaths. <i>Conclusion</i>: The rate of perinatal deaths in this study was relatively low compared to other studies. This reflect the quality of obstetrics care pregnant women received in our facility. And most of these women with early neonatal deaths were referred to our facility from lower health facilities with complications.

Molecular autopsy for fetal structural anomaly: diagnostic and clinical utility of multidisciplinary team approach.

In the West Midlands regional genetics service, cases of perinatal death with a possible genetic diagnosis are evaluated by the perinatal pathology genetic multidisciplinary team (MDT). The MDT assesses autopsy findings and suggests appropriate genomic assessment. The objective of this retrospective service evaluation was to determine the clinical utility of the MDT in assessing perinatal deaths associated with structural anomaly. This is the first evaluation since the introduction of whole-genome and whole-exome sequencing in routine clinical care. This was a retrospective service evaluation including all cases of perinatal death with an associated structural anomaly and suspected genetic etiology that underwent perinatal MDT assessment between January and December 2021. All cases received a full or partial postmortem examination and at least a chromosomal microarray analysis. Demographic characteristics, phenotype, genotype, MDT recommendations, diagnoses, outcomes and impact of postmortem analysis and genetic testing data were collected from patient case notes. Overall, 123 cases were discussed at the MDT meetings in 2021. Genetic evaluation was recommended in 84 cases and accepted in 64 cases. A range of genetic tests were requested according to indication and availability. Thirty diagnoses were made in 29 cases from 26 unrelated families. The diagnostic yield was 24% (29/123) in all cases or 45% (29/64) in cases with a suspected genetic diagnosis who underwent genetic testing. Postmortem examination provided clinically actionable phenotypic data in 79% of cases. A genetic diagnosis enabled accurate recurrence risk counseling and provision of appropriate follow-up, including prenatal testing and preimplantation diagnosis for patients with inherited conditions. Genomic testing was a clinically useful addition to (but not a substitute for) postmortem examination in cases of perinatal death associated with structural anomaly. The MDT approach helped assess cases and plan appropriate follow-up. Expedited whole-genome sequencing or panel-agnostic analysis were most appropriate for heterogeneous presentations. This broad approach can also expand knowledge of prenatal phenotypes and detect novel disease genes, and should be a priority in future research. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.

Perinatal mortality in the municipality of Panchimalco, San Salvador: a case series.

Perinatal mortality is an indicator that reflects the impact of maternal and infant care in a country. This study presents nine cases of perinatal mortality that occurred in the municipality of Panchimalco, El Salvador. The information was obtained from audit reports. The mothers of the deceased infants were aged between 17 and 43 years, did not use contraceptive methods, had incomplete prenatal controls and averaged a gestational age of 31 weeks. Three deliveries were attended in the community. Most perinatal deaths occurred before delivery due to unknown causes, and live births were preterm. We identified factors such as deficits in comprehensive care for women. Further studies are needed to determine the main factors influencing perinatal deaths in El Salvador. Motivation for the study. It is necessary to understand the maternal and infant characteristics of perinatal deaths. Additionally, it is required to generate evidence that contributes to a better understanding of these events. Main findings. Nine cases of perinatal deaths with maternal-fetal risk characteristics were identified. Most deaths occurred before delivery, with prematurity predominating in the neonates. Implications. Understanding the maternal and infant characteristics of perinatal deaths is essential for developing preventive strategies aimed at reducing risk factors related to perinatal mortality.

The correlation between serum total bile acid and adverse perinatal outcomes in pregnant women with intrahepatic cholestasis of pregnancy (ICP) and non-ICP hypercholanemia of pregnancy.

The association between excessive serum total bile acid (TBA) and adverse perinatal outcomes in individuals with non-intrahepatic cholestasis of pregnancy (non-ICP) hypercholanemia has not been determined, and it is unclear if this link is similar to that observed in patients with ICP. To examine the adverse perinatal outcomes in two specific subcategories: those with ICP and those with non-ICP, including individuals with liver disease and asymptomatic hypercholanemia of pregnancy (AHP), at different levels of TBA. Investigate the correlation between TBA levels and adverse perinatal outcomes of ICP, liver disease, and AHP. From 2013 to 2021, pregnant women with excessive TBA levels were taken from the electronic medical record database of our hospital and categorized into three groups: ICP (n = 160), liver disease (n = 164), and AHP (n = 650). This was done as part of a retrospective cohort research project. Multivariable regression and subgroup analyses were performed to examine the association between TBA levels and adverse perinatal outcomes in each group. The study found no significant differences in adverse perinatal outcomes between the ICP and liver disease groups at different TBA levels. However, at moderate TBA levels, both groups had a higher risk of adverse perinatal outcomes than the AHP group (p < 0.017). Among liver disease cases with TBA ≥ 100µmol/L, three cases of perinatal deaths (6.67%) associated with moderate-to-severe acute hepatitis occurred between 27 and 33 weeks of gestation. A 59% higher chance of perinatal death was found for every 10 µmol/L rise in TBA, even after significant variables and confounders were taken into account (adjusted odds ratio (aOR) = 1.59; 95% confidence interval (CI): 1.06-2.40; p = 0.03). If a pregnant woman has moderate-to-severe liver disease and TBA ≥ 100µmol/L, preterm termination of pregnancy (before 34 weeks) may be considered.

A validation of placental pathology reports by ethnicity in New Zealand, through systematic analysis of histological slides

IntroductionReliability studies of placental examination have shown differing interobserver agreement for certain pathological features, a lack of uniform reporting criteria and variable experience among pathologists. In previous analyses we have shown that placental pathology differs by ethnicity. This validation study was performed to investigate whether bias related to ethnicity is a feature of placental pathology reporting in New Zealand (NZ). Methods199 of 1726 eligible perinatal death cases between 2008 and 2017 were selected at random for this audit-type study, including 51 cases from South Asian, Māori and NZ European ethnicity and 46 cases from Pacific mothers. Stored histology slides were blinded and re-examined by an experienced perinatal pathologist, and linked to the corresponding original pathology report. Interobserver agreement (overall, by ethnicity and by gestational age) was described by proportional differences and kappa coefficients. ResultsTotal interobserver agreement between original placental reporting and the validation review was 89.7 %, which differed by pathological feature. There was generally more underreporting than overreporting (3.6 % and 6.7 %, respectively). There was little disagreement by ethnicity (decidual vasculopathy [p = 0.03]), although there were more differences by gestational age (villous morphology [p < 0.01], chorioamnionitis [p = 0.03], high-grade villitis of unknown etiology [p < 0.01], and placental haemorrhage [p = 0.03]). DiscussionNo systematic bias in placental pathology reporting in NZ was identified by ethnicity or gestational age, as observed differences could be related to the underlying prevalence of pathology. We identified more underreporting than overreporting of pathology in the original reports, emphasizing the importance of placental investigation by specialised perinatal pathologists.

Good practices in perinatal bereavement care in public maternity hospitals in Southern Spain

ObjectiveTo assess the attitudes and care practices of midwives and nurses in the province of Granada in relation to death care and perinatal bereavement, to determine their degree of adaptation to international standards and to identify possible differences in personal factors among those who best adapt to international recommendations. DesignA local survey of 117 nurses and midwives from the five maternity hospitals in the province was conducted using the Lucina questionnaire developed to explore professionals' emotions, opinions, and knowledge during perinatal bereavement care. Adaptation of practices to international recommendations was assessed using the CiaoLapo Stillbirth Support (CLASS) checklist. Socio-demographic data were collected to establish their association with increased compliance with recommendations. FindingsThe response rate was 75.4%, the majority were women (88.9%), with a mean age of 40.9 (SD=1.4) and 17.4 (SD= 10.58) years of work experience. Midwives were the most represented (67.5%) and reported having attended more cases of perinatal death (p = 0.010) and having more specific training (p<0.001.) Of these, 57.3% would recommend immediate delivery, 26.5% would recommend the use of pharmacological sedation during delivery and 47% would take the baby immediately if the parents expressed their wish not to watch them. On the other hand, only 58% would be in favour of taking photos for the creation of memories, 47% would bathe and dress the baby in all cases, and 33.3% would allow the company of other family members. The percentage that matched each recommendation on memory-making was 58%, 41.9% matched the recommendations on respect for the baby and parents, and 23% and 10.3% matched the appropriate delivery and follow-up options, respectively. The factors associated with 100% of the recommendations, according to the care sector, were being a woman, a midwife, having specific training and having personally experienced the situation. Key conclusionsAlthough the levels of adaptation observed are more favourable than in other nearby contexts, serious deficiencies are identified in the province of Granada with respect to internationally agreed recommendations on perinatal bereavement care. More training and awareness-raising of midwives and nurses is needed, which also considers factors related to better compliance. Implication for practiceThis is the first study to quantify the degree of adaptation to international recommendations in Spain reported by midwives and nurses, as well as the individual factors associated with a higher level of compliance. Areas for improvement and explanatory variables of adaptation are identified, which allow support for possible training and awareness-raising programmes aimed at improving the quality of care provided to bereaved families.

Associated Factors with Vaginal Delivery on a Uni- or Bi-Scar Uterus in a Low-Resource Setting

Introduction: Delivery in a scar uterus is one of the most debated topics in obstetrics. The objective was to determine the uterine test and the maternal-fetal outcome in patients with uni- and bi-scared uterus who received the uterine test at Panzi General Referral Hospital. Methodology: This is a cross-sectional study with a prospective collection of patients who delivered on a uni- or bi-scareduterus at Panzi Hospital, between January 1, 2021 and August 1, 2022. Results: The average age of the patients was 27.09 years, with an age range of 25 - 34 years, they were mostly married (88.3%), with secondary educational level (60.4%). Pauciparous women, with a history of previous caesarean delivery once, represented respectively 52.2%; 7.2% of parturients with an intergenital space equal to 18 months. 63.9% were overweight, 58.6% had undergone more than three ANC sessions. We noted statistically significant associations between modes of admission, water sac, type of membranes rupture, uterine height and success of uterine test (p 0.05). We did not find significant associations between parturient age, gestational age, intergestational interval, pregnancy term, surgical history, number of ANC performed, number of previous caesarean sections, number of newborns. We did not record any cases of maternal death but one case of perinatal death with 0.9% in this study. Conclusion: A good selection of patients with uni- or bi-scared uterus would allow the reduction of the fetomaternal morbidity during the uterine test.

Association between fetal echogenic and/or dilated bowel and adverse perinatal outcomes.

Echogenic and/or dilated bowel is uncommonly encountered on prenatal ultrasound and may represent either a panel of differential diagnoses or a transient normal variant with excellent outcome. Prenatal differentiation between the two entities remains uncertain. Here, we aimed to review prenatal cases associated with echogenic and/or dilated bowel and analyze their prospective perinatal outcomes. This was a retrospective cohort study, carried out at a single center. All relevant data was retrieved from the hospital electronic records. Bowel echogenicity is defined as grade 0-3, in relation to the surrounding liver or bone echogenicity. Bowel dilatation is defined as the largest diameter >7 mm with the length >15 mm. Out of 59 cases with prenatal echogenic and or dilated bowel, 32 cases were analyzed, and 10/32 (31%) neonates among all categories showed intestine related pathologies that required postnatal care. Two out of 19 (11%) cases with echogenic bowel and one out of three (34%) cases with bowel dilatation revealed structural abnormality that required postnatal surgery. All cases were in stable conditions upon discharge from the hospital. There were no cases of perinatal death associated with bowel abnormalities. Echogenic bowel in isolation carries a low risk for structural bowel anomalies that require surgery. Dilated bowel represents an increased risk for intestinal obstruction. Combination of two ultrasonographic features, echogenicity and dilatation of the intestine should be considered as a suspicious sign of a genetic syndrome which may alter bowel function but may not require surgery.

Clinical features at the time of non-hysteroscopic myomectomy before pregnancy, which affect adverse pregnancy outcomes: a retrospective cohort study

BackgroundTo investigate the association of clinical characteristics at the time of non-hysteroscopic myomectomy before pregnancy and adverse obstetric outcomes in the next pregnancy.MethodsIn this retrospective cohort study, we identified 248 women who underwent abdominal or laparoscopic myomectomy for intramural (IM) and/or subserosal (SS) uterine myomas in Bundang CHA Medical Center before pregnancy and delivered at the same hospital between 2010 and 2020. The association between clinical characteristics at the time of myomectomy and subsequent obstetric outcomes was analyzed using the Chi-square test, the Student t-test or one-way ANOVA, and multivariable analysis.ResultsThere was one case of uterine rupture. The gestational age at delivery was 37.7 ± 2.4 weeks. There were 2 (0.8%) cases of fetal loss before 23 weeks, but there were no cases of perinatal death. The risk of transfusion during or after delivery was higher in the group in which multiple myomas were removed compared to the group in which only one was removed (aOR = 2.41, 95% CI [1.20–4.86], p = 0.014). The risk of neonatal composite morbidity was higher in the group in which myomas including the IM type were removed, than in the group in which only SS myomas were removed (aOR = 14.29, 95% CI [1.82–99.57], p = 0.012). Although not statistically significant, the group in which the sum of the diameters of the three largest myomas was greater than 15 cm showed a higher frequency of preterm birth (19.3% vs. 10.1%, p = 0.001) and lower birth weight (2901 ± 625 g vs. 3063 ± 576 g, p = 0.001) compared to the group with diameters less than 15 cm. Placenta accreta/increta (7.9% vs. 3.8%, p = 0.043) and lower placental weight (646 ± 170 g vs. 750 ± 232 g, p = 0.034) were more common in patients with an interval between myomectomy and pregnancy of less than 12 months compared to more than 12 months.ConclusionsTo our knowledge, this is the first study to investigate the association between clinical features at the time of myomectomy before pregnancy and various adverse obstetric and perinatal outcomes. If the removed myomas are multiple, IM, large, or the interval between myomectomy and pregnancy is short, the risk of obstetric and neonatal complications may increase.

Perinatal deaths in Bursa Province, Turkey: an analysis by applying the International Classification of Diseases-perinatal mortality (ICD-PM) system

Objectives: The International Classification of Diseases for Perinatal Mortality (ICD-PM) system is a globally used classification based on the International Statistical Classification of Diseases and Related Health Problems (ICD-10) codes. Moreover, it focuses on the time of death and maternal conditions. Here, we analyzed perinatal deaths by using the ICD-PM system. Methods: This is a retrospective study, performed between January 1, 2020, and March 30, 2022, in Bursa. Perinatal characteristics and the causes of perinatal deaths were recorded. The perinatal deaths were classified according to the ICD-PM system and descriptives were given. Results: The majority of perinatal death cases (119 cases) occurred in the antepartum period. The leading cause of antepartum deaths was unspecified causes (62.2%) followed by fetal growth disorders (9.3%). A total of 63 (53.7%) mothers were healthy (M5) while 27 (22.7%) mothers had medical or surgical conditions (M4). Acute intrapartum events (33.4%) were the commonest cause of intrapartum deaths followed by unspecified causes (26.6%). When neonatal deaths were analyzed, low birth weight/prematurity constitute 59.6% of neonatal deaths. The largest proportion of mothers was healthy in the intrapartum (40%) while maternal complications of pregnancy (M2) was the most commonest classification for neonatal deaths. Conclusions: ICD-PM is a globally used system for classifying perinatal deaths. The time of perinatal death used in this system provides focus on interventions in perinatal care and it encourages comparison between perinatal care centers. We suggest that we might use resources truly to prevent perinatal deaths in our country by using this system.

Evaluation of role of umbilical cord anomalies in fetal death-An institutional experience

Umbilical cord plays pivotal role in development and well being of fetus. Any abnormality in the umbilical cord can affect the viability of the fetus. In spite of presence antenatal diagnostic modalities still fetal autopsy plays a vital role in identification and confirmation of the abnormalities which lead to intrauterine fetal death. To check for incidence of variety of cord abnormalities in perinatal fetal deaths. It is a retrospective observational study of 26 cases of perinatal deaths due to cord abnormalities taken from Jan 2013 to July 2021 in tertiary care center. In the study 26 cases of fetal autopsy were included over a period of nine years. Mean maternal age was 26 years. 12 cases (44.3%) were of vessel number defects. In which 11 were two vessel cords and the other was 5 vessel cord, 14 cases showed short cord. 8 cases showed normal cord length. 4 cases showed long cords. True knots were seen in one case. 3 cases (28%) were involving stenosed cords. and 5 cases (28.4%) were of supercoiling 3 twisted cords. Maternal co-morbidities were present in 3 cases.Umbilical cord anomaly is a major stress factor for fetus playing a key role in feto-maternal perfusion. Cord abnormalities can be clinically insignificant or can be severe leading to foetal death. The present study reemphasizes the importance of umbilical cord and its impact on wellbeing of foetus. Thus there is need to develop special and exclusive antenatal screening for umbilical cord abnormalities needs further research.

Value of second-trimester uterine artery pulsatility index in pregnancies with systemic lupus erythematosus and/or antiphospholipid syndrome

Objective To assess the value of the second trimester mean pulsatility index of the uterine arteries (MPI-UtA) to predict adverse perinatal outcome (APO) in women with systemic lupus erythematosus (SLE) and/or antiphospholipid syndrome (APS). Methods Pregnancies with either an SLE diagnosis or with primary APS controlled at our Hospital during a 10 years period were included. MPI-UtA was performed between 19–23 weeks' gestation. The MPI-UtA was defined as abnormal when it was >95th centile. APO was defined as the presence of: preeclampsia (PE), small for gestational age (SGA) newborn, preterm delivery, placental abruption and fetal or neonatal death. Results There were 39 ongoing pregnancies, 16 of them with SLE and 23 with primary APS. Nine patients had no previous pregnancy (23%). Globally, 35 live births were recorded, being the mean gestational age at delivery 38.1 ± 2.1 weeks and the mean birth weight 2835 ± 492 g. Abnormal MPI-UtA was found in 6 (15%) pregnancies, all of them (100%) had an APO: there were 4 fetal deaths and 2 further severe PE with live newborn. Normal MPI-UtA was shown in the remaining 33 (84.6%); of them, 6 (18%) had an APO: one late PE with a premature newborn, another one severe preterm baby and 4 SGA term newborns. No cases of perinatal death occurred in this group. Therefore, accuracy of MPI-UtA evaluation for APO was: sensitivity 50%, specificity 100%, PPV 100% and NPV 82%, respectively (p < .001). Conclusion Abnormal second-trimester uterine artery Doppler evaluation is highly predictive for adverse perinatal outcome in pregnancies affected by SLE or APS.

A nationwide surveillance system to reduce perinatal death cases in Italy: implementing apopulation-based pilot project.

to describe the methodology of a pilot perinatal mortality surveillance system (SPItOSS) aimed to improve quality of care and prevent avoidable perinatal severe morbidity and mortality in three Italian regions. population-based surveillance project monitoring incident cases of stillbirths, born dead ≥ 28 weeks of gestation and live births dying within 7 days. Local multidisciplinary audits in obstetric and neonatal units were conducted to assess causes of each death. A selection of deaths was also discussed by experts in regional and national Confidential Enquiries to assess causes and avoidability. The WHO perinatal mortality definition and the ICD-PM classification were adopted to codify perinatal deaths. health professionals working in any obstetric and neonatal unit in Lombardy (Northern Italy), Tuscany (Central Italy), and Sicily (Southern Italy), accounting for 32.3% of births in Italy. Data collection started on 01.07.2017 and ended on 30.06.2019. obstetric and neonatal units' participation rate in the participating regions, facility structural organisation description, health professionals' training course participation, estimate of perinatal death rates, clinical audits and Confidential Enquiries rates. health professionals from all obstetric and/or neonatal units (N. 138) joined the pilot project. Overall, 830 incident perinatal deaths were reported; 699 underwent a facility-based clinical audit, and 94 selected cases were analysed in detail through regional and national Confidential Enquiries. Among the latter, 16.0% were assessed as avoidable deaths. Interregional differences related to the facility structural organisation were identified. SPItOSS was efficient in identifying and analysing incident cases of perinatal deaths and detecting improvable aspects of care and avoidable perinatal deaths. The next objective is to extend the surveillance at the national level, considering that stable funding and a higher number of participating healthcare professionals and experts will be needed.

Анализ факторов риска и структуры перинатальных потерь у беременных с сахарным диабетом

Study Objective: To analyse risk factors and perinatal mortality structure in patients with various types of diabetes mellitus (DM) over the last 30 years in specialised settings. Study Design: retrospective single-site cohort study. Materials and Methods. We have studied 42 medical records containing cases of perinatal death of foetus or newborn in 1988–2018 in patients with DM1 (n = 20), DM2 (n = 10), gestational DM (n = 12). Study Results. The most common complication in pregnancy was preeclampsia combined with chronic placental insufficiency (47.6%). The most common risk factors of perinatal death were inadequate glycemic control in 1st trimester (69.0%), absence of preconception preparations (66.7%), preconception overweight and obesity (42.8%), and chronic arterial hypertension (28.6%). There were 38.1% antenatal deaths, 16.7% intranatal deaths, and 45.2% cases of postnatal mortality. The major causes of perinatal foetal mortality in 26.2% cases were placental disorders, 16.7% were associated with foetus growth retardation, diabetic fetopathy and respiratory distress syndrome. Conclusion. DM during pregnancy was associated with a higher risk of perinatal death. Timely preconception preparation, BMI normalization and a consolidated approach to term and mode of delivery can reduce the risk of perinatal mortality in women with various types of DM. Keywords: diabetes mellitus, gestational diabetes mellitus, perinatal mortality, stillbirth, obesity, preeclampsia

The use of the cerebroplacental ratio in the latent phase of labour to predict adverse outcomes in a resource-limited setting

Background. Risk stratification of pregnant women may decrease the perinatal mortality rate in South Africa. This relies on the assessment of the referring health facility and timeous presentation of the patient. Inaccurate dating affects the ability to detect growth restriction. Patients requiring referral may go undetected and deliver with the inappropriate level of care. Doppler studies can assist in detecting at-risk fetuses. Objectives. To describe the short-term outcomes of fetuses with a normal or abnormal cerebroplacental ratio (CPR) according to the various definitions in the literature. Methods. A cohort of 200 pregnant women were prospectively recruited while in early labour. Patient history including previous ultrasound scans were obtained. Ultrasound was done for biometry, umbilical artery (UA), middle cerebral artery (MCA) and uterine Dopplers, and the CPR was calculated. Labour and delivery details were recorded. An association between an abnormal CPR, adverse outcomes and composite score was determined. Results. Less than a tenth (7.7%; n =15) of the participants had a CPR &lt;1.08. Furthermore, 16.5% ( n =31) of the participants were &lt;5th centile and 24.2% ( n =47) were &lt;10th centile. The composite score of adverse outcomes in those with and without a CPR &lt;5 th centile was not significant ( p =0.737). There was no association between adverse outcomes ( p =0.179) or a composite score ( p =0.237) and the CPR cut-off of the 10th centile. Moreover, there was no association between an abnormal CPR and adverse outcomes after adjusting for confounders. There were no cases of perinatal death or neonatal encephalopathy. Conclusion. An abnormal CPR was not clinically useful in detecting fetuses at risk of adverse outcomes in early labour regardless of the CPR cut-off. However, this is reassuring when normal and may if combined with other parameters still prove useful.

Results of the perinatal audit of the Northwestern Federal District

Aim. To assess the results of a perinatal audit of the Northwestern Federal District and to identify opportunities for a decrease in perinatal mortality.&#x0D; Methods. The audit of perinatal loss was conducted in two stages: (1) remote audit audit of perinatal mortality indicators; (2) medical history audit audit of cases of perinatal death of a child based on medical documentation. Held the copy of the data from the 925 medical records for 220 cases of perinatal death. The perinatal audit of the Northwestern Federal District used the Nordic-Baltic perinatal death classification. The following statistical methods were used for statistical data processing: incidence rate of a trait was determined by using frequency tables, the statistical significance of differences was tested by using contingency tables, the Chi-square criterion, along with the Pearson correlation coefficient. The statistical significance of differences in quantitative indicators was assessed by using Student's t-Test. The significance level was set at p 0.05.&#x0D; Results. It was found that in the Northwestern Federal District pregnancy losses III category of the Nordic-Baltic classification (gestational age newborn, more than 28 weeks, without congenital malformations and intrauterine growth restriction) is 27.5%, intranatal losses VI category of the Nordic-Baltic classification (gestational age newborn, more than 28 weeks, without congenital malformations and intrauterine growth restriction) 7.4%, the loss of newborns VIIIXI category of the Nordic-Baltic classification (gestational age newborn, more than 28 weeks, without congenital malformations and intrauterine growth restriction) 16.9%. Among children who died during the perinatal period, children of gestational age over 28 weeks significantly predominate (p=0.003). In the nosological structure of stillbirth, most of the diseases are associated with respiratory disorders (85.9%), infectious complications are 14.1%. The main causes of death of newborns in the early neonatal period are respiratory disorders 40.0% and infectious diseases specific to the perinatal period 36.0%. The assessment of the sexual prevalence of pregnancy losses did not reveal a statistically significant difference (p=0.29). The assessment of the sexual characteristics of intranatal losses showed that boys significantly predominate (p=0.003).&#x0D; Conclusion. The perinatal audit revealed that, in the Northwestern Federal District, the level of the mobile reserve of perinatal losses associated with managed causes is 51.8%.

A Retrospective Study of Mortality Causes in Arabian Horses

This study aims to describe the causes of death in Arabian horses at Al Wathba, in Abu Dhabi (United Arab Emirates) during 2018-2019. This study was conducted in a cohort of all Arabian horses that died. Data was collected retrospectively and only those horses with a full necropsy report available were included in the study. The carcass and all internal organs of each horse were examined and representative samples of tissues with abnormalities were collected in 10% neutral buffered formalin and processed for histopathological examination. A descriptive statistical analysis was performed. A total of 25 Arabian horses were examined post-mortem. Out of them, 35% were females. In general, colic occurred specifically at a higher frequency (80%), cases of collapse and sudden death during exercise and races occurred in 8%, cases of perinatal death in 8% and one case of laminitis (4%). The annual mortality in relation to the estimated population was 1% approximately. In conclusion, we identified and described the causes of death in Arabian horses in Al Wathba, Abu Dhabi, UAE during the period 2018-2019. In summary, a pathology of the digestive system specifically acute abdominal crisis (colic) is the main cause of death in Arabian horses, with 80%; other causes of mortality with a low incidence were in order collapse and sudden death during exercise and races, perinatal death and laminitis. These results allow establishing risk prevention measures of mortality in horses for specific activities like handling, feeding, training and races

Deciphering congenital anomalies for the next generation.

Congenital anomalies are common, with 2%–3% of infants estimated to have at least one major congenital malformation and countless others with minor malformations of lesser cosmetic or medical importance. As congenital malformations are major drivers of morbidity and mortality, representing the leading cause of infant mortality in the United States, there is substantial interest in understanding the underlying etiologies—particularly if modifiable causes may be identified or pre- or postnatal treatments can be offered. Recent research has begun to reveal the spectrum of monogenic disorders that commonly result in birth defects, and newer approaches have revealed non-Mendelian genetic contributions including gene–environment interactions. Our experience suggests that increased efforts to sequence and analyze cases of perinatal death, as well as continued global collaboration, will be essential in understanding the genomic landscape of structural anomalies.