Cases Of Stillbirth Research Articles

Dysregulated low-density granulocyte contributes to early spontaneous abortion.

Spontaneous abortion (SA) is a common adverse pregnancy event with unclarified pathogenesis and limited therapeutic efficiency. Although most SA cases with the euploid embryo(s) are associated with immunological factors, the contribution of low-density granulocyte (LDG) in SA pathogenesis is rarely reported. This study aimed to investigate the serial characteristics and possible contribution of LDG and their subpopulations in early pregnancy, especially in early SA. Unpregnant (UP), normally pregnant (NP), and SA women were recruited, and the peripheral blood and endometrium/decidua were collected for LDG isolation and histological observation. The percentage, phenotype, and subpopulations of LDG were analyzed via flow cytometric analysis, and the ability of Nets formation was assessed by immunofluorescent and immunohistochemical assays. As a result, 43 participants were enrolled, including 10 UP, 15 NP, and 18 SA women. Compared with the UP group, the LDG percentage in peripheral blood mononuclear cells (PBMCs) and decidual immune cells (DICs) increased in the NP group, while the loss of this increase was observed in the SA group. Meanwhile, CD16int/- cell percentage in peripheral blood LDG (PB-LDG) increased in the NP and SA groups, and insufficient activation of CD16hi PB-LDG characterized by reduced CD11b expression was discovered in the SA group. Moreover, the LDG percentage in DICs was higher than that in PBMCs, and the decidual LDG (D-LDG) showed a surface marker expression profile that is easier to be activated in the pregnant cohort (NP + SA women). Finally, increased decidual Nets formation was observed in the SA group compared with the NP group, and more Nets formation was detected in D-LDG of NP and SA women following PMA stimulation. Overall, LDG participates in the maintenance of early pregnancy, while dysregulated LDG is responsible for early SA, providing novel potential targets for further exploration of SA pathogenesis and therapeutics.

Risk of stillbirth in singleton fetuses with advancing gestational age at term: A 10-year experience of late third trimester prenatal screenings of 50,000 deliveries in a referral center in northern Italy.

The risk of intrauterine death (IUD) at term varies from less than one to up to three cases per 1,000 ongoing pregnancies. The cause of death is often largely undefined. Protocols and criteria to prevent and define the rates and causes of stillbirth are the subjects of important scientific and clinical debates. We examined the gestational age and rate of stillbirth at term in a 10-year period at our maternity hub to evaluate the possible favorable impact of a surveillance protocol on maternal and fetal well-being and growth. Our cohort included all women with singleton pregnancies resulting in early term to late term birth at our maternity hub between 2010 and 2020, with the exclusion of fetal anomalies. As per our protocol for monitoring term pregnancies, all women underwent near term to early term maternal and fetal well-being and growth surveillance. If risk factors were identified, outpatient monitoring was initiated and early- or full-term induction was indicated. Labor was induced at late term (41+0-41+4 weeks of gestation), if it did not occur spontaneously. We retrospectively collected, verified, and analyzed all cases of stillbirth at term. The incidence of stillbirth at each week of gestation, was calculated by dividing the number of stillbirths observed that week by the number of women with ongoing pregnancies in that same week. The overall rate of stillbirth per 1000 was also calculated for the entire cohort. Fetal and maternal variables were analyzed to assess the possible causes of death. A total of 57,561 women were included in our study, of which 28 cases of stillbirth (overall rate, 0.48 per 1000 ongoing pregnancies; 95% CI: 0.30-0.70) were identified. The incidence of stillbirth in the ongoing pregnancies measured at 37, 38, 39, 40, and 41 weeks of gestation was 0.16, 0.30, 0.11, 0.29, and 0.0 per 1000, respectively. Only three cases occurred after 40+0 weeks of gestation. Six patients had an undetected small for gestational age fetus. The identified causes included placental conditions (n = 8), umbilical cord conditions (n = 7), and chorioamnionitis (n = 4). Furthermore, the cases of stillbirth included one undetected fetal abnormality (n = 1). The cause of fetal death remained unknown in eight cases. In a referral center with an active universal screening protocol for maternal and fetal prenatal surveillance at near and early term, the rate of stillbirth was 0.48 per 1000 in singleton pregnancies at term in a large, unselected population. The highest incidence of stillbirth was observed at 38 weeks of gestation. The vast majority of stillbirth cases occurred before 39 weeks of gestation and 6 of 28 cases were SGA, and the median percentile of the remaining case was the 35th.

Studi Korelasi Pengaruh Kualitas Pendampingan Suami Terhadap Perubahan Tingkat Kecemasan Ibu Pada Persalinan


 
 
 
 According to data from the World Health Organization (WHO), the percentage of possible abortion is quite high, around 15-40%. In Indonesia, it is estimated that there are 500,000-750,000 abortions. Blighted ovum is a state of the product of conception that does not contain a fetus. It is estimated that worldwide Blighted ovum is 60% of the causes of miscarriage cases, in ASEAN (association of Southeast Asian Nations) it reaches 51%, in Indonesia it is found 37% of every 100 pregnancies, in Yogyakarta Province it reaches 30% of 100 pregnancies and in Sleman Regency. as much as 43.39% (WHO, 2015). The incidence rate at PKU Muhammadiyah Gamping shows an increase in the Blighted ovum rate during the last 3 years in 2016 as much as 6.02%, in 2017 it increased by 6.05%, and in 2018 it increased by 6.06% (Kemenkes RI, 2018). Mothers who experience abortions due to blighted ovum have characteristics including age, parity, nutrition and gestational spacing, in addition, age, parity, nutrition and gestational spacing are also factors that cause blighted ovum.
 Objective: To identify the factors that influence the incidence of blighted ovum pregnancy.
 Research Methodology: This type of research is analytical observational with a cross-sectional approach. The location of this research is PKU Muhammadiyah Gamping Yogyakarta with a sample of 30 respondents and the sampling technique is Simple Random Sampling. The data analysis technique used in this research is chi square.
 Research Results: Factors related to the incidence of blighted ovum pregnancy are parity factors as indicated by a p-value of 0.004 where the p-value is smaller than the significance value with an error rate of 5% (0.05). This shows that there is a relationship between the parity variable and the incidence of blighted ovum pregnancy. For the nutrition variable, the p-value is 0.151 where the p-value is greater than the significance value with an error rate of 5% (0.05). This shows that there is no relationship between nutritional variables and the incidence of blighted ovum pregnancy.
 
 
 

Non-invasive prenatal testing for everybody or contingent screening?

To compare the advantages and disadvantages of two main implementation strategies for non-invasive prenatal testing (NIPT) for the detection of trisomies 21, 13 and 18 in public healthcare settings. These concern NIPT as a first-tier screening test for all pregnant women, or NIPT contingent on an increased risk first-trimester combined test (FCT) result. Comparison based on (un)published data and literature. Despite the lower prevalence of trisomies in the low-risk population, data show that the positive predictive value (PPV) and detection-miscarriage ratio of first-tier NIPT are comparable to NIPT used as contingency test. Advantages of NIPT as a first-tier test compared to FCT with contingent NIPT are that there is no time-window for testing, sensitivity is higher, fewer women need follow-up testing (PPV of NIPT is higher than PPV of FCT), less anxiety for pregnant women and partners. When given the choice, pregnant women prefer first-tier NIPT. Although contingency testing still seems to be the cheaper option, the differences in costs are becoming increasingly smaller and might soon disappear. We argue that NIPT should preferably be offered as a first-tier test for the detection of fetal aneuploidies for all pregnant women, provided that women are supported to make informed decisions. This article is protected by copyright. All rights reserved.

Vertical Transmission of Severe Acute Respiratory Syndrome Coronavirus 2: Current Evidence and Perspectives

Vertical Transmission of Severe Acute Respiratory Syndrome Coronavirus 2: Current Evidence and Perspectives

The Outcome of Obesity in Pregnancy: A Cross-Sectional Study

Objective: To find out fetal and maternal outcomes among obese pregnant females.
 Study Design: Cross-sectional study.
 Place and Duration of Study: Department of Gynaecology and Obstetrics, Combined Military Hospital Rawalpindi, from Jun 2020 to Jun 2021.
 Methodology: A total of 124 pregnant obese women (BMI more than 30kg/m2), gestational age between 13-24 months, having fasting blood glucose and blood pressure within normal limits were enrolled in the study and were subsequently followed throughout pregnancy upon antenatal visits scheduled as per guidelines. Participants with diabetes mellitus or hypertension,above 40 years of age, family or previous history of gestational diabetes, and pre-eclampsia were also excluded from the study. Fetal and maternal outcomes were noted.
 Results: One hundred and twenty-four (124) pregnant obese women were enrolled in the study with a mean age of 33.7±4.1 years (21 -38 years). Out of which, 86(69.4%) had cesarean section primarily due to pre-eclampsia, prolonged or dysfunctional labour causing fetal distress. There were 8 cases of miscarriage and 3 cases of stillbirth. 26(21.0%) women presented with gestational diabetes mellitus, 31(25.0%) with pre-eclampsia and 12(9.7%) developed both conditions. There were 7(5.6%) participants who delivered babies with macrosomia, 1(0.8%) anencephaly, 3(2.4%) congenital deafness and 1(0.8%) cleft lip.
 Conclusion: Obesity in pregnancy can lead to serious maternal and fetal outcomes ranging from abortions to neonatal anomalies and fetal death. A high index of suspicion is required to diagnose and manage these difficult conditions.

Comparison of Dydrogesterone and GnRH-a Effects After Laparoscopic Surgery in Patients with Stage III and IV Endometriosis.

To compare the spontaneous pregnancy rates between dydrogesterone and Gonadotropin-releasing hormone agonist (GnRH-a) treatments in patients with endometriosis stage III and IV after laparoscopy. The clinical data of patients with endometriosis stage III and IV administered laparoscopic surgery in our hospital from January 2018 to March 2020 were retrospectively analyzed. Totally 151 cases were divided into two groups according to postoperative medication, including the study (70 cases) and control (81 cases) groups treated with dydrogesterone and GnRH-a, respectively. The spontaneous pregnancy and subsequent pregnancy outcomes were assessed within 12 months. Totally 49 patients had spontaneous pregnancy. Among them, there were 31 cases in the dydrogesterone group (spontaneous pregnancy rate of 44.3%, 31/70), including 25 live birth cases (35.7%, 25/70), 4 miscarriage cases, and 2 ectopic pregnancy cases. The time to conception was 1-10 months (median value of 5 months). Totally 18 cases in the GnRH-a group had spontaneous pregnancy (22.2%, 18/81), including 16 live birth cases (19.8%, 16/81). 81) and 2 miscarriage cases; the time to conception was 3-11 months (median value of 6 months). There were significant differences in spontaneous pregnancy rate and cumulative spontaneous pregnancy rate between the two groups (P = 0.005 and 0.003, respectively). Dydrogesterone after laparoscopic surgery in patients with endometriosis stage III and IV improved the natural pregnancy rate.

Analysis of Causes of Stillbirth in a Tertiary Care Hospital using ReCoDe Classification System: A Prospective Observational Study

Introduction: Stillbirths account for a major proportion of perinatal deaths. In many cases of stillbirth, the cause remains unexplained. The ReCoDe system (classification of stillbirths by relevant condition at death) is a frequently used classification system that has helped us to improve the understanding of the causes of stillbirths. Aim: To identify factors associated with stillbirths and to classify the causes of stillbirths using the ReCoDe system. Materials and Methods: A prospective observational study was conducted in the Department of Obstetrics and Gynaecology, Government Medical College and Rajindra Hospital, Patiala, Punjab, India, from February 2020 to January 2021. All the mothers with a history of antepartum and intrapartum foetal mortality with the diagnosis of intrauterine foetal death after 20 weeks of gestation were included in the study. A detailed history of the mother was taken and an examination of the mother, stillborn babies, placenta, and umbilical cord was done. ReCoDe system was used to classify the causes of stillbirth. For statistical analysis mean and percentages were used. Results: There were 287 women with intrauterine foetal death admitted during the study period. Maternal age ranged from 18- 40 years, majority (n=157, 54.7%) women belonged to the age group of 24-29 years. The stillbirth rate was 78.95 per 1000 live births. The cause of stillbirth could be explained in 235 (81.89%) cases by using the ReCoDe system. Hypertensive disorders in 91 (31.71%) were the most common cause followed by foetal growth restriction in 46 (16.02%). Conclusion: ReCoDe system was useful in classifying the causes of stillbirths in the resource-limited settings.

The addition of dydrogesterone improves the outcomes of pregnant women with low progesterone levels when receiving vaginal progesterone alone as luteal support in HRT-FET cycles.

Vaginal progesterone (VP) alone has been used as luteal support (LS) in HRT-FET cycles without measuring serum progesterone concentrations (SPC) because it can achieve adequate intrauterine progesterone levels. However, several reports showed that the co-administration of progestin produced better outcomes than VP alone. We tried to address this discrepancy, focusing on SPC. VP was given to 180 women undergoing HRT-FET. We measured SPC when pregnancy was diagnosed on day 14 of LS. We compared assisted reproductive technology outcomes between VP alone versus VP + dydrogesterone (D). When using VP alone, average SPC in the miscarriage cases (9.6ng/mL) were significantly lower compared with the ongoing pregnancy (OP) cases (14.7ng/mL). The cut-off value for progesterone, 10.7ng/mL, was a good predictor for the subsequent course of the pregnancy. Of 76 women receiving D ± VP from the start of LS and achieving a pregnancy, the numbers of OP were 44 (84.6%) in SPC≥ 10.7ng/mL and 20 (83.3%) in SPC ≤ 10.7ng/mL with no significant difference. VP alone resulted in lower SPC in some pregnant women in HRT-FET cycles and exhibited a lower OP rate. The co-administration of D improved an OP rate of low progesterone cases to the level comparable with non-low progesterone cases.

Risk Factor of Stillbirth among Pregnant Women at Dr. Hasan Sadikin General Hospital Bandung from 2017–2020

Background: Stillbirth is one of the most devastating pregnancy outcomes that affects approximately 2.6 million pregnancies worldwide. Several factors have been identified to be associated with stillbirth, and grouped based on the pathophysiological aspects, such as maternal, placental, fetal, and unknown or unexplained factors. This study aimed to describe the prevalence, along with the baseline and risk factor characteristics of stillbirth among singleton pregnancies at Dr. Hasan Sadikin General Hospital Bandung. Methods: A descriptive, cross-sectional study design was conducted, including all stillbirth medical records from 2017 to 2020 obtained from the Department of Obstetrics and Gynecology, Dr. Hasan Sadikin General Hospital Bandung. Medical records with complete baseline data, 2nd–3rd trimester pregnancies, and singleton pregnancies were collected.Results: The prevalence of stillbirth cases in this study was 2.2%. Most of the cases occurred in the age range of 20–35 years old (64.4%) with the gestational age of >28 weeks (65.8%). Of all risk factors observed, hypertensive disorders were the most common medical conditions found (45.6%), followed by unknown factors (17.8%), and congenital abnormalities (14.2%).Conclusions: The majority of stillbirth patients are at their optimal reproductive age, nulliparity, and have hypertensive disorders during pregnancy, specifically the superimposed preeclampsia subtype. Although the prevalence is considerably low, early management of the risk factors, particularly hypertensive disorder, is important to prevent its occurrence.

DYNAMICS OF MISCARRIAGE AMONG THE FEMALE POPULATION OF FERTILE AGE IN UKRAINE AND IN LVIV REGION IN 2014-2021

Aim. The research aims at rationalizing of the epidemiological component in the process of developing a model for preventing miscarriage among the female population of Ukraine.
 Materials and Methods. A retrospective analysis of the indicators of miscarriage among the female population of Ukraine and Lviv region for the period from 2014 to 2021 was carried out. Statistical data of the Center for Medical Statistics of the Ministry of Health of Ukraine were used, namely Form No. 21 "Report on medical care for pregnant women, women in labor and women giving birth". The study uses the methods of a systemic approach and structural-logical analysis, medical-statistical analysis, namely the calculation of chain (relative to the previous year) indicators of a dynamic series: absolute growth, growth rate and increment rate.
 Results and Discussion. A decrease in the female population of fertile age by 13.03% in Ukraine and by 5.81% in Lviv region was noted in the analyzed period of 2014-2021, while the number of spontaneous abortions in Ukraine decreased by an average of 3.45% per year, and grew in Lviv region in 2015, 2018, 2019 and 2020 by 5.72%, 6.87%, 19.29% and 6.59%, respectively. The rates of spontaneous abortions per 1,000 women of fertile age in Lviv region were twice as low as in Ukraine. Over the analyzed 8-year period, the share of premature children among all live births increased from 4.68% to 5.68% in Ukraine, and from 4.18% to 5.65% in Lviv region, respectively; these indicators in Lviv region were smaller compared to the indicators in Ukraine. The share of premature babies among stillbirths averaged 63.07% in Ukraine and 67.69% in Lviv region, had a growing trend, and the indicators in Lviv region were higher every year compared to the indicators in Ukraine. The ratio of the total rate of miscarriage to the total number of pregnancies (cases of miscarriage per 100 pregnancies) increased from 5.50 in 2014 to 6.22 in 2021 in Ukraine and from 3.57 to 4.72 in Lviv region respectively.
 Conclusions. There was a trend of annual increase in the index of the ratio of the total miscarriage rate to the total number of pregnancies, the share of prematures from the total number of live births and the share of premature births from the number of stillbirths in the analyzed 8-year period, both in Ukraine and in Lviv region. The analyzed indicators of the share of premature newborns from the total number of live births in Lviv region were lower every year, and the share of newborns from the total number of stillbirths was higher compared to the average annual indicators in Ukraine. The dynamics of spontaneous abortions showed a clear trend towards an annual decrease in Ukraine and their increase in 2015, 2018-2020 in Lviv region. The rate of spontaneous abortions among women of fertile age in Lviv region from 2014 to 2021 was annually half as low compared to the average annual levels of this indicator in Ukraine.

Expectant management of advanced abdominal pregnancies: Is it justifiable?

ObjectiveTo evaluate the outcome of a case series of women with advanced abdominal pregnancies (AAP) who underwent expectant management. Study designA retrospective study that utilized prospective data of 46 women who were admitted for expectant management at a tertiary hospital in Durban, South Africa. All data was analyzed descriptively and presented in percentages. ResultsThe average period of expectant management was 27 days; thirty-three (72 %) of the 46 women were discharged from the hospital with live babies. There were 11 (24 %) neonatal deaths and two cases of stillbirths. There were no maternal deaths and morbidity was minimal. ConclusionWhen diagnosed after the 24th week of gestation, an option is expectant management which includes careful patient selection, prolonged hospitalization, and close antenatal fetal and maternal surveillance to achieve fetal viability. Management by experienced clinicians and a multidisciplinary team in a tertiary institution is recommended. Informed consent needs to take into consideration the risks with interventional laparotomy, social separation from family and friends, and the guarded perinatal outcome.

A Comparative Analysis of Anticardiolipin, Anti-Β2-Glycoprotein-1, and Lupus Anticoagulants in Saudi Women with Recurrent Spontaneous Abortions.

Association and pathogenesis of antiphospholipid antibodies (APAs) in patients with Antiphospholipid syndrome (APS) as well as systemic lupus erythematosus (SLE) suffering from unexplained spontaneous abortions is controversial. Moreover, the majority of the published evidence is based on the patient histories rather than the study groups. The main objective of the present study is to do a comparative analysis of the high levels of antiphospholipid antibodies (APAs) including anticardiolipin (ACA), anti-β2-glycoprotein-1 (β2 GP1), and Lupus anticoagulants (LA) and their association with the gestational age of abortion and duration past abortion in Saudi women. In this study, 100 women living in Makkah city, located in the Western region of Saudi Arabia, with a mean age of 30.5 ± 12.60 years (mean ± standard deviation), having a previous history of recurrent spontaneous abortions were enrolled as case group and 100 healthy pregnant women previously having one or more successful pregnancies were selected as control group. Based on the gestational age of the patient’s miscarriages, our results revealed consistently and significantly high levels of ACA, β2 GP1, and LA, being greatest at more than 15 weeks when compared with 10 weeks and 11−15 weeks, respectively. Based on duration of past miscarriages, a slightly increased level was observed at ≤4 years after their first miscarriage. In addition, less or more equal levels of these antibodies were observed at 5−12 and more than 12 years in all the cases of miscarriages. We concluded an elevated pattern of APAs in these patients with an increase in the age of abortion. A comparison between the levels of ACA, β2 GP1, and LA further indicated a highly significant level of LA in all the cases of abortions (p < 0.0005).

Causes of death in stillbirth and quality of care—an example of a local audit

AbstractIntroductionNeonatal deaths have decreased steadily in Sweden since the 1960s, but the stillbirth rate has been stable at around 4 per 1000 births, for the last 40 years. Risk factors of stillbirth are well studied; however, the cause of death is unclear in many cases. The purpose of this study was to examine causes of death in stillbirth using a classification system. In addition, we aimed to assess substandard care factors and identify areas for quality improvement.Materials and MethodsWe performed a retrospective clinical audit of all stillbirths delivered between January 2006 and December 2019. We performed a detailed investigation of medical records and classified the causes of death according to ‘The Stockholm classification of stillbirth’. Unclear cases were discussed in a multidisciplinary local audit group. Substandard care factors were identified and classified as probable, possible, or unlikely, with respect to the cause of death.ResultsIn total, there were 64 cases of stillbirth. It was possible to determine a cause of death in 91% (95% confidence interval [CI]: 81.02–95.63) of the cases. The leading cause of death was intrauterine growth restriction (IUGR)/placental insufficiency (45%) (95% CI: 33.73–57.43), followed by infection (13%) (95% CI: 6.47–22.8) and placental abruption (9%) (95% CI: 4.37–18.98). Factors of substandard care were identified in 49% (95% CI: 37.06–61.4) of the cases, but in only 10% the substandard care factor had a probable association with the cause of death.ConclusionIntroducing a local audit group and using a validated classification system made it possible to find a cause of death in about 90% of the cases of stillbirth. Since IUGR/placental insufficiency is the leading cause of death, it is important to improve current strategies to identify pregnancies at risk for IUGR, antenatally. Our results suggest that there is a possibility to improve the quality of care in many areas, particularly regarding symphysis‐fundus measurements.Tweetable AbstractA validated classification system and local audits are valuable tools to determine the causes of IUFD. This enables directed preventive actions toward IUFD.

Validation of claims-based algorithms to identify non-live birth outcomes.

Perinatal epidemiology studies using healthcare utilization databases are often restricted to live births, largely due to the lack of established algorithms to identify non-live births. The study objective was to develop and validate claims-based algorithms for the ascertainment of non-live births. Using the Mass General Brigham Research Patient Data Registry 2000-2014, we assembled a cohort of women enrolled in Medicaid with a non-live birth. Based on ≥1 inpatient or ≥2 outpatient diagnosis/procedure codes, we identified and randomly sampled 100 potential stillbirth, spontaneous abortion, and termination cases each. For the secondary definitions, we excluded cases with codes for other pregnancy outcomes within ±5 days of the outcome of interest and relaxed the definitions for spontaneous abortion and termination by allowing cases with one outpatient diagnosis only. Cases were adjudicated based on medical chart review. We estimated the positive predictive value (PPV) for each outcome. The PPV was 71.0% (95% CI, 61.1-79.6) for stillbirth; 79.0% (69.7-86.5) for spontaneous abortion, and 93.0% (86.1-97.1) for termination. When excluding cases with adjacent codes for other pregnancy outcomes and further relaxing the definition, the PPV increased to 80.6% (69.5-88.9) for stillbirth, 86.6% (80.5-91.3) for spontaneous abortion and 94.9% (91.1-97.4) for termination. The PPV for the composite outcome using the relaxed definition was 94.4% (92.3-96.1). Our findings suggest non-live birth outcomes can be identified in a valid manner in epidemiological studies based on healthcare utilization databases.

Pathological features of early pregnancy disorders in women living at high altitude in KSA

ObjectivesPregnancy at high altitudes is relatively challenging because of hypobaric hypoxia, which is associated with a smaller uterine artery diameter and diminished blood flow. Here, we investigated the histopathological characteristics of early pregnancy disorders among pregnant women living in a high-altitude region (approximately 2200 m above sea level). MethodsThis cross-sectional study used retrospective data collection from a single tertiary hospital in a high-altitude region in KSA. Age and histopathology were analyzed in 495 women diagnosed with early pregnancy disorders (mainly miscarriage) in 2018–2020. ResultsApproximately one-fifth of pregnancies in this high-altitude region were lost before 24 weeks’ gestation, whereas 1150/6044 experienced miscarriage; 495 samples from those participants were sent for histopathological analysis. A total of 269 (54.34%) patients were younger than 35 years. Missed miscarriages accounted for 49.3% of miscarriages, followed by inevitable miscarriages (34.2%), which had a relatively higher frequency among mothers older than 35 years. The correlation between age and inevitable miscarriage was significant; ectopic pregnancy was diagnosed in 6.8%, molar pregnancy was detected in 6.26%, and blighted ovum was observed in 3.4%. ConclusionThe miscarriage rate in this high-altitude region was 19% of all pregnancies. Approximately half of the affected women were in their 30s. Missed miscarriage cases were relatively high in this region. The percentage of molar pregnancy was higher than those reported in prior studies, thus suggesting a need for monitoring and genetic workup practices. Furthermore, studies involving a larger population at high altitudes will be crucial for further risk assessment in addition to national studies on women living at sea level.

P046Impact of birthing volumes on abortion provision and surgical miscarriage management

<h3>Objectives</h3> Pregnancy is a condition with a finite number of outcomes, including birth, abortion, and pregnancy loss. Existing studies describe seasonality trends for birth and abortion, but no studies assess relationships between birthing volumes and surgical abortion or surgically managed early pregnancy loss (SEPL) volumes. To evaluate relationships between obstetric outcomes, we designed this retrospective review of birth, abortion, and SEPL volumes at our medical center. <h3>Methods</h3> This retrospective ecological study utilized CPT billing codes to detail birth, abortion, and SEPL volumes at Vanderbilt University Medical Center from 2011 to 2019. Abortion and miscarriage cases were validated by individual chart review by the study team. Data were plotted on line and bar graphs to evaluate changes over time and relationships between outcomes. <h3>Results</h3> A total of 50,472 obstetric outcomes occurred in the study period. Proportions of White and Black patients were similar in the birth and composite abortion SEPL outcomes (68.2% vs. 71.6%; 15.5% vs. 17.4%). Both birth and surgical abortion volumes per year essentially doubled (3,511 to 6,573, 13–29); SEPL volume increased by a factor of 2.6 (115–268). The proportions of abortions and SEPL outcomes remained constant throughout the study period (0.4% and 3.4%). <h3>Conclusions</h3> As birthing volumes increase, so do abortion and SEPL volumes. Outcome proportions remained stable over time; these proportions can be used to estimate future abortion and SEPL volumes based on anticipated delivery volumes. When increasing delivery volumes, medical centers must prepare for increases in patients experiencing the breadth of obstetric outcomes.

Second-trimester miscarriage: a review of postnatal investigations and subsequent pregnancy outcomes.

Second-trimester loss is pregnancy loss after the 12th and before the 24th completed weeks of pregnancy. This study aims to review cases of second-trimester miscarriage who attended a large maternity hospital and to examine pregnancy outcomes in this group of women. This study is a review of cases of second-trimester miscarriage using descriptive, exploratory design, involving a retrospective chart review. In this study, 106 cases of second-trimester miscarriage were reviewed. The cause of the miscarriage was found in 42.5% (n = 45) of cases. The majority of women, 84.5% (n = 82) had a normal pelvic ultrasound scan and 18.3% (n = 17) of cases were diagnosed with antiphospholipid syndrome. In women who became pregnant again, 60.9% (n = 39) had a live birth. Establishing the cause of second-trimester miscarriage can be challenging, despite completing all recommended investigations. Outcomes in subsequent pregnancies are reassuring. This review highlights the need to undertake all recommended investigations to elicit the cause of second-trimester miscarriage and underpins the need for further research in this area.

Risk Factors of Preterm Birth in Okinawa Prefecture, the Southernmost Island Prefecture of Japan.

A high rate of preterm birth has been reported in Okinawa Prefecture, the southernmost island prefecture of Japan. Hence, this study aimed to identify the risk factors for preterm birth in this prefecture. This retrospective study included data from January 2013 to December 2019 from three facilities in Okinawa Prefecture. Of 13,468 cases of preterm birth at ≥ 22 weeks of gestation, 11,868 were included in this study. Stillbirth and multiparity cases were excluded. First, we compared the overall preterm and full-term birth groups by categorizing the patient background, obstetric, and fetal risk factors. Further, we categorized preterm births into three groups (22-27, 28-33, and 34-36 weeks of gestation) and examined patient background factors to identify potential risk factors for the occurrence of preterm birth in each group. Preterm births accounted for 21.2% (2,521 cases) of all cases, with the rates of 2.6% (317 cases), 6.7% (800 cases), and 11.8% (1,404 cases) at 22-27, 28-33, and 34-36 weeks of gestation, respectively. To prevent preterm birth in Okinawa Prefecture, the present study specifically focused on patient background characteristics. In the multinomial logistic regression, the risk factors for preterm birth at 22-27 weeks of gestation were previous preterm birth (P < 0.0001) and lower age (P = 0.026); at 28-33 weeks of gestation, the risk factors were previous preterm birth (P < 0.0001) and history of cervical conization (P = 0.009); and at 34-36 weeks of gestation, only previous preterm birth (P < 0.0001) was a risk factor. Previous preterm birth, younger age, and history of cervical conization were risk factors for Preterm birth in Okinawa. To reduce premature births in Okinawa Prefecture, it is important to pick up women with these risk factors and provide them with appropriate guidance and education on an ongoing basis.

Reproductive Losses and Their Causes in Alpacas-A Survey-Based Study.

The profitability of alpaca breeding depends on satisfactory reproductive results. The study aimed to analyze the frequency and causes of reproduction-related problems in alpacas, in particular miscarriages, stillbirths, preterm births, twin pregnancies, and falls of crias within 12 months after birth. This analysis was carried out with the use of questionnaires completed voluntarily by 109 alpaca owners in three regions (British Isles, Continental Europe, and North America). Cases of miscarriage and stillbirths were reported from 44% and 36% of the farms, respectively. In half of the farms, the cases of falls of crias and young alpacas within 12 months after birth were reported. Preterm births were reported from almost half of the farms. A large number of alpaca owners did not identify the cause of fetal death. An important element increasing the cria survival rate of is the birth weight (the higher cria birth weight, the lower risk of perinatal complications and less necessity of bottle feeding). Crias from dams receiving mineral supplements had higher birth weight. This study indicated a relationship between fetal death and the occurrence of infectious diseases and scabies infestation in the herd. They may be potential causes of reproduction-related problems that are not discerned in time.