Cause Of Fetal Death Research Articles

Late Intrauterine Foetal Death in a Tertiary Centre of Bangladesh

Background: Late intrauterine foetal death (IUFD > 28 weeks) is a tragedy to mothers and family members. The first step to reduce IUFD is to obtain an accurate and detailed data for IUFD. The present study was done to identify the probable causes of foetal death and determine the risk of recurrence, prevention or corrective action. Methods: This prospective observational study was conducted in a tertiary hospital during a period of one year in Chattogram Maa-O-Shishu Hospital Medical college, from January to December 2018, on all admitted pregnant women with intrauterine foetal death (>28 weeks). Detailed history, clinical examination, associated conditions, mode of delivery, foetal conditions, placenta, condition of cord and investigation reports were analyzed. Results: A total of 188 IUFD were reported amongst 8013 deliveries with its incidence 23.46/1000 live birth and recurrence rate 8.5%. Maximum (89.89%) occurred in antepartum period. Mean maternal age 26.03 years. 59% unbooked cases, 48.93% belonging to lower class family and maximum (59%) from slum and rural area. Most of the cases were Multigravidas (59.6%) and preterm (52.7%) gestation. Regarding causes of IUFD hypertensive disorders in pregnancy (45.2%) were commonest, followed by unexplained 24.5%, diabetes Mellitus and gestational diabetes mellitus (23.9%), anaemia 20.7%, hypothyroidism 11.2%, oligohydramnios 11.2%, maternal infection 9.6%, antepartum haemorrhage 8.5%, malpresentation 7.44%, intrauterine growth retardation 4.8%, fetal congenital anomalies 4.8% & cord accident 4.3%. Maternal complications occurred 14.9% cases. Those were postpartum haemorrhage 11.2%, sepsis 2.6%, acute renal failure 0.53% and disseminated intravascular coagulation (DIC) 0.53%. Most of the patients (86.2%) delivered vaginally. Maximum number of IUFD was seen in birth weight between 1 - 1.5 kg (31.4%), followed by 2 - 2.5 kg (21.8%). Conclusions: HDP, GDM and anaemia were major causes of IUFD. Most of the causes of IUFD may have been preventable by pre-conceptional councelling, regular antenatal checkup, proper screening, early diagnosis and treatment. Large number IUFD remained unexplained. So, to unravel the complex pathophysiology of IUFD further study is needed.

Placental pathology in intrauterine fetal death

Placenta is the most accessible and readily evaluable specimen which is mirror image of pregnancy. The objective here is to study the histomorphological changes in placenta in cases of intrauterine fetal deaths and to study correlation of placental findings with causes of fetal death which is significant to understand. The present cross sectional study was carried out in Department of Pathology of a tertiary care hospital from June 2015 to May 2017. Study of Placental Pathology in Intrauterine Fetal Death cases comprised of 99 placentas. The present study was undertaken to study the placental pathology in cases of intrauterine fetal death. IUFD was found to be more common in primigravida 50/99 (50.50%) mothers. Placental study gives useful morphological information regarding the abnormality of pregnancy. Gross and microscopic examination of the placenta plays an important role in identifying the underlying causes of fetal death and helps prevent further recurrence by making appropriate interventions during the next pregnancy. Study of placental pathology gives clues to events occurring throughout gestation and can potentially help to answer, questions concerning pregnancy management and risk assessment of future pregnancies. It will help the researchers who are doing the research in the field of placental pathology in the days to come.

Fetal Metabolomic Alterations Following Porcine Reproductive and Respiratory Syndrome Virus Infection.

PRRSV infection in third-trimester pregnant sows can lead to fetal death and abortions, although the mechanisms triggering these effects are not well understood. Since resistant and susceptible fetuses can coexist in the same litter, we propose that there may be differential mechanisms used by some fetuses to evade infection and/or disease progression. Our objectives were to investigate possible differences in the metabolome of PRRSV-infected and non-infected fetuses, as well as the interaction of altered intrauterine growth development and PRRSV infection to elucidate possible causes of fetal death following PRRSV infection. Near-term serum samples collected from fetuses on gestation day 106, 21 days post PRRSV-2 infection, were processed by direct flow injection mass spectrometry (DI-MS) and nuclear magnetic resonance (NMR) techniques. Experiment one investigated disease progression with 24 fetuses selected from each of four phenotypic groups: fetuses from non-inoculated gilts (CTRL); fetuses from inoculated gilts that escaped infection (UNINF); infected high viral load viable fetuses (INF); and infected high viral load meconium-stained fetuses (MEC). Experiment two investigated the interaction of intrauterine growth retardation (IUGR) and PRRSV infection by analyzing differences among: non-infected normal development (CON-N); CON-IUGR; PRRS infected normal development (PRRS-N); and PRRS-IUGR. Univariate and multivariate (PCA, PLS-DA) statistics determined group differences among various contrasts, and the most important metabolites associated with disease progression and fetal development. Significant differences in the metabolome were observed, especially between PRRSV-negative fetuses (CTRL and UNINF) and MEC fetuses, while INF fetuses appear to span both groups. The two metabolites with highest variable importance in projection (VIP) scores related to disease progression were alpha-aminoadipic acid (alpha-AAA) and kynurenine (KYN), having the highest concentration in MEC and INF fetuses, respectively, compared to CTRL and UNINF. In experiment two, non-IUGR fetuses were found to have increased levels of lysoPCs, PCs and amino acids compared to IUGR fetuses, while the near complete absence of lysoPCs and PCs in IUGR fetuses, even during infection, indicate a distinctive response to infection compared to non-growth retarded fetuses. Possible markers of PRRSV fetal susceptibility, such as alpha-AAA, kynurenine and lysoPCs, are presented and discussed.

Umbilical cord constriction as a cause of intrauterine fetal death

ABSTRACT The umbilical cord constriction (UCC) is an uncommon condition and an important etiology for stillborn fetuses. The main goal of this study was to verify the UCC occurrence as the cause of intrauterine fetal death, the associated etiology and its pathological characteristics. Therefore, a descriptive retrospective cross-sectional study was developed using the database from a Pathology Institute, in Brazil, from 1995 to 2017. The results presented a total of 1,359 embryo/fetus deaths – 69 (5.07%) due to UCC, 60.9% males and 39.1% females. The average age of pregnant women was 27.5 years ± 7.2 years of standard deviation (SD). The majority of deaths occurred during the second trimester (76.5%), followed by the first (14.7%) and third (8.8%) trimesters, respectively. One constriction alone was found in 87% of cases, 11% had two constrictions and only 1% had three or more. The presence of congenital malformations was detected in 20.2% of necropsies, the identification of chronic fetal distress was described in 71% of the technical reports and 17% of the cases had obstructive vasculopathy characteristics in microscopy analysis. Regarding the anatomopathological characteristics between the male and female sexes, no significant difference was found (p > 0.05) correlating gestational age, weight or congenital malformations. UCC was a cause of fetal death found in 5% of the cases, and it was linked to congenital malformations, fetal distress and obliterative vasculopathy.

Living with the Dead

Intrauterine twin gestation with death of one foetusleads to anxiety in the mind of patient, relatives and even obstetrician. Fetal demise of a twin in the first trimester (vanishing twin) is not very rare and does not impair the development of the surviving twin. However Fetal death in late second and third trimester increase the risk of complications for the surviving co twin such as IUGR, preterm labor, neurodevelopmental impairment and maternal complications such as maternal coagulopathy, preeclampsia, sepsis and perinatal mortality. The causes of fetal death vary and include twin to twin transfusion, placental insufficiency, IUGR, preeclampsia, velamentous insertion of cord, cord around neck, congenital anomaly, etc. The objective of this study is to ascertain the prognosis of the surviving co twin to aid counseling of patients and foreground future research.

Análise dos óbitos fetais ocorridos em uma maternidade de referência

Objetivo: Analisar os óbitos fetais, segundo características sócio-demográficas, clínicas e critérios de evitabilidade, ocorridos em uma maternidade. Métodos: Estudo retrospectivo dos óbitos fetais ocorridos no período de 2014 a 2017. Elaborou-se uma planilha no Excel 2010, com as variáveis contidas na ficha de investigação de óbitos fetais. Realizaram-se análises descritivas e classificaram-se as causas dos óbitos, conforme critério de evitabilidade, por faixa de peso (1500g-2500g; >2500g). Resultados: Ocorreram 1029 óbitos no período. A taxa de mortalidade fetal foi de 25,1/1000 nascidos vivos (NV) em 2013 e 26,1/1000 NV em 2017. 39,9% das mães tinham entre 20 a 40 anos e 39,9% possuíam mais 8 anos de estudo. As patologias mais citadas durante a gravidez foram: hipertensão arterial/DHEG (33,1%), hemorragia/ DPP/ placenta prévia (31,1%) e infecção urinária (20,1%). No momento da internação, 38,4% apresentavam amniorrexe prematura sem trabalho de parto, 9,7% pré-eclampsia grave e 9,1% apresentaram descolamento prematuro da placenta. As principais intercorrências durante o parto foram: eclampsia / hipertensão (25,6%), hemorragia (20,2%). Dos 570 óbitos fetais (acima de 1500g) analisados, 84,9% ocorreram por causas evitáveis, 4,9% por causas não claramente evitáveis e 10,2% por causas mal definidas. As principais causas dos óbitos fetais evitáveis (n=484) foram classificadas como: reduzíveis por adequada atenção à mulher na gestação (56,6%) e adequada atenção à mulher no parto (36,4%) e adequada atenção ao recém-nascido (7,0%). Conclusão: os achados revelam uma proporção alta de óbitos fetais que poderiam ser evitados com ações voltadas a melhoria na qualidade da assistência ao pré-natal e ao parto.

Aneuploidy and DNA Methylation as Mirrored Features of Early Human Embryo Development.

Genome stability is an integral feature of all living organisms. Aneuploidy is the most common cause of fetal death in humans. The timing of bursts in increased aneuploidy frequency coincides with the waves of global epigenetic reprogramming in mammals. During gametogenesis and early embryogenesis, parental genomes undergo two waves of DNA methylation reprogramming. Failure of these processes can critically affect genome stability, including chromosome segregation during cell division. Abnormal methylation due to errors in the reprogramming process can potentially lead to aneuploidy. On the other hand, the presence of an entire additional chromosome, or chromosome loss, can affect the global genome methylation level. The associations of these two phenomena are well studied in the context of carcinogenesis, but here, we consider the relationship of DNA methylation and aneuploidy in early human and mammalian ontogenesis. In this review, we link these two phenomena and highlight the critical ontogenesis periods and genome regions that play a significant role in human reproduction and in the formation of pathological phenotypes in newborns with chromosomal aneuploidy.

Fetal Autopsy-Categories and Causes of Death at a Tertiary Care Center.

A fetus is defined from 8 weeks after conception until term while in the uterus. Fetal death is defined as death of the fetus before the complete expulsion or extraction from the mother, irrespective of the duration of pregnancy that is not an induced termination of pregnancy. The causes of fetal death determined after fetal autopsy can be categorized according to the classification proposed by Cunningham and Hollier as fetal, placental, and maternal. All fetuses dying in utero, that is, prior to birth, regardless of the gestational age, to the mothers admitted in the Department of Obstetrics and Gynecology along with the respective placentas were received in the Department of Pathology, MGM Medical College, Aurangabad, after an informed and written consent from October 26, 2017, to October 30, 2019, and were included in this study. Clinical details along with obstetric history and antenatal ultrasonographic findings were also recorded. Anthropometric examination of the fetus was performed and evisceration was then done using the Rokitansky technique. Representative sections from each of the organs were taken and kept in tissue cassettes and processed for routine hematoxylin and eosin staining. This study was done on 33 cases of fetal death. Most fetal deaths occurred in the gestational age between 15 and 19 weeks (14 cases [42.42%]) and the least amount during 35 to 39 weeks (2 cases [6.06%]). The cause of death could not be ascertained in 6 cases (18.18%), whereas the maximum cases had fetal factor as the cause of death (15 cases [45.45%]). Maternal causes were seen in only 4 cases (12.12%). Gestational hypertension was seen to be the most common maternal factor associated with fetal death, which comprised 24.24% of cases (8 of 33). Thirteen of the total 33 cases did not have any associated obstetric complication. Of the total 33 fetal deaths, only 7 had associated placental defects on gross examination. Twenty-six placentas did not show any gross abnormality. Of these 7 cases, 5 were seen to have placental infarction. Fetal autopsy is a valuable and cost-effective modality for the confirmation of cause of fetal death. Fetal autopsy can also prove beneficial to the parents in planning for future pregnancies. Fetal autopsy can serve as the ultimate tool in diagnosing cause of fetal death in cases where no other diagnostic clue is available. Therefore, it should be encouraged and couples to be counseled regarding its importance and clinical utility.

Effectiveness of community-based folate-oriented tertiary interventions on incidence of fetus and birth defects: a protocol for a single-blind cluster randomized controlled trial

BackgroundBirth defects are the main cause of fetal death, infant mortality and morbidity worldwide. However, the etiology of birth defects remains largely unknown. Maternal folate status during periconception plays an important role in organogenesis and folic acid supplement reduces the risk of neural tube defects, congenital heart diseases, and several other birth defects. This trial seeks to evaluate the effectiveness of folate-oriented tertiary interventions during periconception on the incidence of fetus and birth defects.MethodsThis is a single-blind, two-arm cluster randomized controlled trial in Shanghai, China. Eligible women from 22 clusters are recruited at pre-pregnancy physical examinations clinical settings. Compared to the routine perinatal care group (control arm), folate-oriented tertiary interventions will be provided to the intervention arm. The core interventions consist of assessments of folate status and metabolism, folate intake guidance, and re-evaluation of folate status to ensure red blood cell folate level above 400 ng/ml (906 nmol/L) before pregnancy. Screening and consulting of fetus and birth defects, and treatments of birth defects during pregnancy and afterward will be provided to both arms. The primary outcome is a composite incidence of fetus defects, stillbirth, and neonatal birth defects identified from the confirmation of pregnancy to 28 days after birth. Secondary outcomes include maternal and offspring adverse complications and cost-effectiveness of folate-oriented tertiary interventions. This protocol adheres to the SPIRIT Checklist.DiscussionTo achieve the recommended folate status before or during pregnancy is still a challenge worldwide. This community-based cluster-randomized controlled intervention trial will evaluate the effectiveness of a package of interventions aiming at achieving recommended maternal folate status covering pre- and during pregnancy in reducing fetus and birth defects. Our study has the potential to improve the community-based practice of reducing modifiable risk factors of disease and improving primary prevention of the defects in China. The procedures would formulate the policy on folic acid supplementation during periconception against birth defects in primary care settings.Trial registrationClinical Trial Registry, NCT03725878. Prospectively registered on 31 October 2018.

Furcate insertion of the umbilical cord: pathological and clinical characteristics in 132 cases.

Objectives Furcate cord insertion is a rare abnormality affecting approximately 0.1% of all pregnancies. Macroscopically, the umbilical vessels separate before reaching the placenta, lose their Wharton's jelly, and insert at the placenta centrally, eccentrically, or marginally. The aim of this retrospective study was to determine the prevalence of furcate cord insertion more accurately, the pathological characteristics, and clinical outcomes. Methods We conducted a retrospective study of 132 cases of furcate insertion of the umbilical cord using the pathological database of the Charité University Hospital Berlin, Germany, between 1993 and 2016. This included 99 cases, including one termination of pregnancy within our institution and 33 cases from external hospitals. An analysis of the pathological features of the 132 cases and the perinatal outcome of the 98 cases within our institution were performed. Results Furcate cord insertion occurred in 0.16% pregnancies. Of the 132 cases, seven cases of intrauterine fetal deaths were observed. Three of those could be linked to the furcate cord insertion. In two of those cases, single umbilical vessel rupture was identified as the cause of fetal death. Conclusions In most cases of furcate cord insertion, the outcome is good; however, intrauterine fetal death occurs in approximately 1.02% of cases.

Stillbirth in women with diabetes: a retrospective analysis of fetal autopsy reports

Introduction Diabetes in pregnancy is associated with an increased rate of stillbirth. There are a wide variety of factors that have been implicated including placental insufficiency, hypoxia, hyperinsulinemia and impaired cardiac function. Furthermore, there is evidence that diabetic pregnancies have an increased rate of fetal cardiomyopathy as compared to non-diabetic pregnancies. Prior studies have indicated that this association can also be an etiology for diabetic stillbirth. The purpose of this study was to determine if diabetic pregnancies have an increased risk of fetal cardiomyopathy identified on fetal autopsy as compared to non-diabetic women with a stillbirth in a cohort of pregnancies that had evaluation with a fetal autopsy. Materials and methods Retrospective cohort study of women with a stillbirth who consented to fetal autopsy at an academic medical center from 2011 to 2017. Stillbirth was defined as an intrauterine fetal demise at ≥20 weeks’ gestation. Women with diabetes defined as pre-gestational diabetes type 1, pre-gestational diabetes type 2, and gestational diabetes were compared to women without diabetes. Primary outcome was fetal cardiomyopathy. Other etiologies for stillbirth were also evaluated and classified according to the Stillbirth Collaborative Research Network (SCRN) initial causes of fetal death. Fisher exact test, χ2 test, and Mann Whitney U tests were performed as appropriate, with p < .05 considered significant. Generalized linear models were performed for fetal organ weights controlling for gestational age of delivery, maternal chronic hypertension, delivery body mass index, and birthweight. Results A total of 78 women elected to have fetal autopsy examinations during the study period. Of these, 75 had complete information available for review. A total of 60 women did not have diabetes and 15 women had diabetes. Of pregnancies complicated by diabetes, 11 had insulin dependent diabetes and 4 had non-insulin dependent diabetes. Fetal cardiomyopathy was diagnosed on autopsy for 7 (46.7%) of pregnancies with diabetes and 2 (3.3% of pregnancies without diabetes (RR 14.00 [95% CI 3.23–60.65], p < .001). These associations were still significant even when analyzing only those pregnancies without fetal congenital heart disease (7 [46.7%] diabetic pregnancies with cardiomyopathy versus 1 [2.0%] nondiabetic pregnancy with cardiomyopathy, RR 23.80 [95% CI 3.17–178.46], p < .001). There was no difference between diabetic and non-diabetic pregnancies in regards to other causes for stillbirth. Stillbirths in pregnancies with diabetes also had larger fetal heart, liver, and adrenal weights on fetal autopsy. Conclusion Women with diabetes have 14 times the risk of fetal cardiomyopathy identified at fetal autopsy as compared to women without diabetes. As the prediction and prevention of diabetic stillbirth is limited, information on potential causes of stillbirth may help future research identify those pregnancies at the greatest risk for adverse outcome.

Classifying stillbirths in a tertiary care hospital of India: International Classification of Disease-perinatal Mortality (ICD-PM) versus cause of death-associated condition (CODAC) system

A number of classification system are available to classify stillbirths, but there remains a lack of a uniform global system of classification. This study evaluated the feasibility of the ICD-PM classification system and COD-AC to classify the stillbirths and to discuss the interpretation of “the newer” classification system (ICD-PM) over the COD-AC system. Over a period of one year, out of 5776 total births 314 were stillborns with a stillbirth rate of 54 per 1000 total births. As per ICD PM Classification System, 69.1% of stillbirths were ante partum and rest intrapartum. The associated maternal conditions at the time of foetal death were also classified into five groups and maximum mothers (44.3%) were grouped under M4-medical/surgical disorders. According to COD-AC system of classification 90% of cases were assigned the cause of death, rest 10% remained unexplained. The ICD-PM and CODAC classification both seem to be feasible but ICD-PM clearly defines the time of foetal death and correlates feto-maternal dyad together. IMPACT STATEMENT What is already known on this subject? Classifying stillbirths is crucial to recognise the actual cause of foetal death and to gather the relevant information for planning the preventive strategies especially in low middle-income countries (LMICs) which contribute to 98% of total global burden of 2.6 million stillbirths annually. In literature CODAC system was found most suitable for low middle-income countries. In 2016, WHO proposed a newer system, i.e., ICD-PM: WHO application of ICD-10 to deaths during the perinatal period. What do the results of this study add? With ICD-PM classification stillbirths were categorised more clearly in different groups and feto-maternal condition were linked together along with both intrapartum and ante partum stillbirth which can help to set the priorities and future planning for prevention. The proportion of unexplained stillbirth has also reduced significantly compared to CODAC system. What are the implications of these findings for clinical practice and/or further research? CD-PM system of classification seems feasible and would facilitate the uniform and consistent stillbirth data even from LMICs for global comparison although more number of studies are needed for conclusion. The system has been changed to ICD-PM in our institute.

The enemy of the good in assigning cause of fetal death.

The enemy of the good in assigning cause of fetal death.

Dystocia: factors affecting parturition in domestic animals.

Abstract Dystocia frequently develops when some physical obstacle or functional defect impedes the birth process. Due to the complex nature of the factors involved in the process of parturition, it may be difficult to distinguish between eutocia (normal delivery) and dystocia (difficult birth). It is essential to do so because the physiopathological effects of problematic labour often deteriorate the dam's fertility and, in severe cases, may cause her death as a result of damage to the genital apparatus and the secondary development of systemic infections. Also, if parturition is not successful, neonates could suffer prolonged episodes of hypoxia, which represents a leading cause of foetal death in cases of dystocia and, even when not fatal, can be a determining factor in neonatal survival. Given this, a better knowledge of the aetiology and physiopathology of dystocia will be keys to understanding this condition and adequate decision making in obstetrical practice and veterinary perinatology. Moreover, such knowledge will permit the timely identification of cases that require special attention and establishing actions to protect animal welfare and assess risks that, on occasion, will entail pharmacological control of eutocia or dystocia. Hence, this paper aims to review some of the most critical aspects involved in the process of difficult deliveries and their consequences for the dam and the foetuses of domestic animals.

ESTUDO DO AUMENTO DE CASOS DE ÓBITOS EMBRIONÁRIOS E FETAIS DIAGNOSTICADOS POR ULTRASSONOGRAFIA DURANTE O SURTO DE ZIKA VÍRUS

The aim of the research was to describe the main causes of fetal death to improve the quality of care for pregnant women. The Zika virus is a virus of the Flavoviridae family, the Dengue and Chikungunya viruses also belong to this family and are transmitted by the Aedes mosquito. There is a concern of the World Health Organization and the Ministry of Health with the increase in cases of Zika virus in pregnant women, since infection with this virus can lead to the presence of neurological changes, such as microcephaly and fetal loss diagnosed by pelvic or transvaginal obstetric ultrasound. . During the period of outbreak of Zika virus infection, there was an increase in cases of deaths diagnosed by ultrasound examination, in the period from 2005 to 2020. Conclusion: The survey identified the socioeconomic level, the obstetric background, the lack of adequate medical monitoring during prenatal care and difficulty in reporting, which are factors that are directly involved with the difficulty of investigating the causes of fetal/embryonic deaths.

An Observational Pilot Study Evaluating the Utility of Minimally Invasive Tissue Sampling to Determine the Cause of Stillbirths in South African Women.

BackgroundDespite approximately 2.6 million stillbirths occurring annually, there is a paucity of systematic biological investigation and consequently knowledge on the causes of these deaths in low- and middle-income countries (LMICs). We investigated the utility of minimally invasive tissue sampling (MITS), placental examination, and clinical history, in attributing the causes of stillbirth in a South African LMIC setting.MethodsThis prospective, observational pilot study undertook sampling of brain, lung, and liver tissue using core biopsy needles, blood and cerebrospinal fluid collection, and placental examination. Testing included microbial culture and/or molecular testing and tissue histological examination. The cause of death was determined for each case by an international panel of medical specialists and categorized using the World Health Organization’s International Classification of Diseases, Tenth Revision application to perinatal deaths.ResultsA cause of stillbirth was identifiable for 117 of 129 (90.7%) stillbirths, including an underlying maternal cause in 63.4% (n = 83) and an immediate fetal cause in 79.1% (n = 102) of cases. The leading underlying causes of stillbirth were maternal hypertensive disorders (16.3%), placental separation and hemorrhage (14.0%), and chorioamnionitis (10.9%). The leading immediate causes of fetal death were antepartum hypoxia (35.7%) and fetal infection (37.2%), including due to Escherichia coli (16.3%), Enterococcus species (3.9%), and group B Streptococcus (3.1%).ConclusionsIn this pilot, proof-of-concept study, focused investigation of stillbirth provided granular detail on the causes thereof in an LMIC setting, including provisionally highlighting the largely underrecognized role of fetal sepsis as a dominant cause.

The Correlation Between Stillbirth and Related Risk Factors: A Case-Control Study

Background: Stillbirth is one of the unfavorable consequences of pregnancy. Generally, the true causes of fetal death are complicated and difficult to accurately identify. Objectives: The present study was aimed to identify risk factors for stillbirth among mothers referring to health centers of Hormozgan province, Iran. Methods: This case-control study was conducted in 12 cities of Hormozgan province in 2015. The samples were randomly selected among those referring to the health centers of Hormozgan province by cluster sampling. Required data were collected by using a researcher-made questionnaire comprised of demographic characteristics of the mother pregnancy and delivery. The univariate and multivariate logistic regression analyses were used to measure the correlation between variables within a significance level of 5%. Data analysis was performed using SPSS, version 21. Results: A total of 825 mothers were recruited and assigned into two groups, experimental and control groups. There were 403 mothers with a history of stillbirth in the experimental group, and the control group was comprised of 422 mothers with a healthy live birth. The average age of the participants in the experimental and control groups were 27.68 ± 6.4 and 26.96 ± 5.4 years, respectively. Most of the mothers (&gt; 90%) in both groups were housewives and most mothers in the case group (37%) were illiterate, whereas the majority of controls (43%) had a university education. The odds of stillbirth among mothers older than 35 years was 2.33 times higher than other mothers [OR: 2.33, 95% CI (1.287 - 4.246)]. The odds of stillbirth among mothers with a history of stillbirth was 10 times higher than those with no stillbirth history [OR: 10.1, 95% CI (2.846 - 35.973)]. Conclusions: The findings of this paper show that the fetal death is associated with maternal age, maternal education, maternal area of living, history of stillbirth in previous pregnancies and history of abortion in previous pregnancies. The results of this study may help to conduct future research effectively, and help supervisors and policymakers make evidence-based operational decisions.

Effects of cigarette smoke components on myocardial differentiation of mouse embryonic stem cells.

The heart is the first organ formed in the developing fetus, and abnormal development of the heart is a major cause of fetal death. The adverse effects of cigarette smoke on the heart have been well established, but it is not well understood how cigarette smoke components regulate signaling molecules and cardiac specific functions during the early differentiation stage of the embryonic heart. In this study, we identified changes in the size of mouse embryoid bodies (mEBs) in response to treatment with cigarette smoke extract (CSE) via regulation of HDAC2, p53, p21, and cyclin D1 protein expression, which are cardiac differentiation and cell-cycle markers, respectively. In addition, exposure of mouse embryonic stem cells (mESCs) to cigarette smoke components inhibited myocardial differentiation and development through the expression of HDAC1, HDAC2, GATA4, NKX2-5, TBX5, HAND1, and Troponin I. Long-term exposure studies showed that CSE and nicotine may delay the development of mouse cardiomyocytes from mESCs and inhibit the contractibility, which is a fundamental function of the heart. Taken together, these findings suggest that cigarette smoke components, including nicotine, may affect abnormal myocardial differentiation and development.

Severe Maternal Morbidity Among Stillbirth and Live Birth Deliveries in California.

To assess the prevalence and risk of severe maternal morbidity among delivery hospitalization for stillbirth compared with live birth deliveries. Using data from the Office of Statewide Health Planning and Development in California, we performed a population-based cross-sectional study of 6,459,842 deliveries between 1999 and 2011. We identified severe maternal morbidity using an algorithm comprising diagnoses and procedures developed by the Centers for Disease Control and Prevention and used log-binomial regression models to examine the relative risk (RR) of severe maternal morbidity for stillbirth compared with live birth deliveries, adjusting for maternal demographic, medical, and obstetric characteristics. We also examined severe maternal morbidity prevalence by cause of fetal death among stillbirth deliveries. The prevalence of severe maternal morbidity for stillbirth and live birth was 578 and 99 cases per 10,000 deliveries, respectively. After adjusting for maternal demographic, medical, and obstetric characteristics, the risk of severe maternal morbidity among stillbirth deliveries was more than fourfold higher (adjusted RR 4.77; 95% CI 4.53-5.02) compared with live birth deliveries. The severe maternal morbidity prevalence was highest among stillbirths caused by hypertensive disorders and placental conditions (24 and 19 cases/100 deliveries, respectively), and lowest among stillbirths caused by fetal malformations or genetic abnormalities (1 case per 100 deliveries). Women who have stillbirths are at substantially higher risk for severe maternal morbidity than women who have live births, regardless of cause of fetal death. The prevalence of severe maternal morbidity varies by cause of fetal death.

Nitrosatable drug exposure during pregnancy and risk of stillbirth

Nitrosatable drugs can react with nitrite in the stomach and form N-nitroso compounds. Exposure to nitrosatable drugs has been associated with congenital malformations and preterm birth, but use during pregnancy as a cause of fetal death is not well-known. We examined if prenatally nitrosatable drug use is associated with risk of stillbirth. A nationwide cohort was conducted using 554 844 women with singleton and first recorded pregnancies regardless of previous pregnancy history from the Danish Medical Birth Register from 1996 to 2015. Exposure was recorded by use of the Danish National Prescription Register and defined as women who had redeemed a prescribed nitrosatable drug in the first 22 weeks of pregnancy. The reference group was women with no redeemed prescribed nitrosatable drug in this time period. We categorized nitrosatable drugs as secondary amines, tertiary amines, and amides. Cox hazard regression was used to estimate crude and adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) for stillbirth. Among the 84 720 exposed women, 348 had a stillbirth compared with 1690 stillbirths among the 470 124 unexposed women. Women who used any prescribed nitrosatable drug were more likely to have a stillbirth compared with unexposed women (aHRs 1.24; 95% CI, 1.03-1.49). Nitrosatable drug use during the first 22 weeks of pregnancy might increase risk of stillbirth. The findings should be interpreted cautiously because of important unmeasured factors that might influence the observed association, including maternal vitamin C intake, dietary, and other sources of nitrate/nitrite intake.