Cause Of Fetal Death Research Articles

Incidence and outcome of severe ante-partum hemorrhage at the Teaching Hospital Yalgado Ouédraogo in Burkina Faso.

BackgroundHemorrhage is the main cause of maternal death during pregnancy. This study aims to evaluate incidence and outcomes of Severe Ante Partum Hemorrhage (SAPH) during the third trimester of pregnancy prior to delivery.MethodsAnalytical cross-sectional study with prospective data collection during 12 months in Yalgado Ouedraogo Hospital, Ouagadougou, Burkina Faso. In this context SAPH is specifically referring to Ante Partum Hemorrhage (APH) and Intra Partum Hemorrhage (IPH) in the 3rd trimester. Postpartum Hemorrhage (PPH) was not included.ResultsDuring our study 7,469 women were admitted in obstetrics and 122 cases of SAPH were recorded. SAPH represented 1.6% (n = 122) of hospitalizations causes and 14.5% (n = 1083) of hemorrhages during pregnancy. Mean age was 27.8 ± 6.9 years, mean parity 2.8 ± 1.3 and mean duration of pregnancy was 37 Weeks Amenorrhea (WA). Evacuation from other facilities was the main mode of admission (91.8%, n = 112) and blood transfusion was the essence of resuscitation. Complications were observed in 80.3% (n = 98). During the study, 118 maternal deaths were reported of which 15.6% (n = 19) related to SAPH. Among SAPH cases who died (n = 19) majority (n = 16) had severe anemia (n = 16; 82.6%, p = 0.004). Ten women (8.19%) were admitted in Intensive Care Unit (ICU). Fifteen premature births (12.3%) and 22 perinatal deaths (18.1%) were recorded. Evacuation (p = 0.04), critical clinical condition during admission (p = 0.004), and Uterine Rupture (UR) (p = 0.002) were associated with poor outcome. The Retroplacental Hemorrhage (RPH) (40.9%) was the most common cause of fetal death (p = 0.005) and was associated with High Blood Pressure (HBP) and pre-eclampsia.ConclusionAPH is a complication associated with significant maternal and fetal morbidity and mortality.

Epidemiology of Intrauterine Fetal Deaths: A Retrospective Observational Study

Background: Intrauterine fetal death is a very tragic event for the parents and a great challenge to the obstetrician. It contributes to perinatal mortality and detail analysis of it may help to reduce the still birth rate in India. The aims and objectives of the study is to find out the prevalence, socio-demography, maternal risk factor and fetal characteristics of intrauterine fetal demise cases. Methods: This is a retrospective observational study carried out in Institute of Medical Science and SUM Hospital Bhubaneswar from October 2014 to April 2015. Ante partum events leading to fetal demise were recorded, socio-demographic and clinical characters were noted and analysed. Results: There were 2899 deliveries and 90 fetal deaths in this period. The incidence of IUFD was 31.04/1000 live births in our study. Conclusion: Pregnancy induced hypertension, severe anaemia; abruption of placenta, congenital malformation of the fetus is the main cause of fetal demise. All the main causes of fetal death observed here is preventable. Proper preconceptional counselling, antenatal care is mandatory to reduce the still birth rate by 2030.

Factors associated to fetal death in Cuiabá, Mato Grosso

Abstract Objectives: to investigate the causes and the factors associated to fetal death in Cuiaba, Mato Grosso, 2006-2010. Methods: a population based case-control study in a ratio of 1:3 (300:900), was based on secondary data on Live Births and Mortality Information Systems. A hierarchical logistic regression was used. Results: remains independently associated to fetal death: low maternal schooling (OR=1.58, CI95%=1.02;2.47), low weight (OR=5.59, CI95%=3.22;9.70) gestational age <37 weeks (OR=9.34, CI95%=5.38;16.21), previous fetal death (OR=6.65, CI95%=4.35;10.15). The type of cesarean delivery remained as a protective factor (OR=0.35, CI95%=0.24;0.54). The main causes of fetal deaths were by unspecified cause (15.4%), followed by maternal hypertensive disorders (14.7%). The fetal mortality rate (TMF) decreased from 10.0 in 2006 to 7.5 deaths per thousand births in 2010 (decreased 24.5%). The TMF during the study period was below the goal set for 2030 by the World Health Organization. Conclusions: approximately one third of fetal deaths causes were potentially avoidable. Factors such as low maternal schooling, low birth weight, prematurity and previous fetal death history constitute as main determinants for fetal deaths in Cuiaba and suggests that socioeconomic situation still determines quality care for pregnant women and that actions should be directed to improve prenatal care.

A new fetal death classification system

Stillbirth is the mayor contributor to perinatal mortality. To report a system for classification of fetal deaths. Retrospective cohort study of 29,916 births with 258 fetal deaths that occurred in a public hospital. Data were obtained from audit reports of stillbirths. The method for classification “obstetric condition relevant to the death” was applied, based on obstetric and placental pathological findings analyzed exclusively by a single obstetrician and a single pathologist. Ninety two percent of obstetric conditions causing fetal death were identified. The most commonly reported were ascending bacterial infection in 26%, congenital anomalies in 19%, arterial hypertension in 12% and placental pathology in 12%. Fetal growth restriction was identified in 50% of stillbirths. Ninety percent were secondary to a primary obstetric condition and 10% had an unexplained cause. Placental abruption as the final cause of fetal death was identified in 60% of cases with arterial hypertension, 43% of cases with placental pathology and 37% of ascending infections. Fetal deaths occurred during pregnancy in 82% of cases and during labor in 17%. Intrapartum asphyxia occurred in 0.8% of stillbirths and presented in term pregnancies. The “obstetric condition relevant to the death” method for classification of fetal death is effective to identify the originating obstetric cause of stillbirth and reduces the impact of fetal growth restriction and intrapartum asphyxia as the leading causes of death.

Post-mortem magnetic resonance foetal imaging: a study of morphological correlation with conventional autopsy and histopathological findings.

The aim of the present study is to offer our experience concerning post-mortem magnetic resonance (PMMR) in foetal death cases and an evaluation of the differences between the findings acquired by PMMR and by forensic autopsy. Fifteen foetuses were recruited from July 2014 to December 2015. These had suffered intrauterine death in women in the 21st to 38th week of gestation who were treated in the emergency department for non-perception of foetal movements. We performed a PMMR on foetuses, 3±1days on average from the time of death, and then a complete forensic autopsy was performed. All 15 foetuses were examined with a whole-body study protocol, starting from the skull, down to and including the lower limbs. The total time of examination ranged from 20 to 30min in each case. The external evaluation and description of post-mortem phenomena (maceration), record of the weight and detection and the various measurements of foetal diameters were evaluated before performing autopsy. A complete histopathological study was performed in each case. Out of 15 cases examined, eight were negative for structural anatomical abnormalities and/or diseases, both in the preliminary radiological examination and the traditional autopsy. In the remaining seven cases, pathological findings were detected by PMMR with corresponding results at autopsy. PMMR can provide useful information on foetal medical conditions and result in improved diagnostic classification. It may enable the planning of a more suitable technique before proceeding to autopsy, including focusing on certain aspects of organ pathology otherwise not detectable. The association between PMMR, post-mortem examination and related histological study of the foetus-placenta unit could help reduce the percentage of cases in which the cause of foetal death remains unexplained. Lastly, it may allow a selective sampling of the organ in order to target histological investigations.

Importancia de la autopsia y del estudio de la placenta en la evaluación de la muerte fetal en el Hospital Universitario de Santander

Objetivo: evaluar las causas de muerte fetal, mediante antecedentes clínicos maternos, análisis de los hallazgos de la autopsia fetal y estudio de la placenta. Materiales y Métodos: se realizó un análisis retrospectivo de 332 muertes fetales durante el periodo comprendido de 2005-2009 ocurridas en el Hospital Universitario de Santander (HUS) Bucaramanga, Colombia. Se incluyeron análisis histopatológicos de la placenta y el feto. Se planteó la siguiente clasificación de las causas de muerte fetal 1) Hipoxia fetal intrínseca 2) Anomalías congénitas 3) Infecciones ascendentes 4) Traumatismos del parto 5) Hidrops fetal. Se determinaron como no clasificables a fetos macerados. Se establecieron subgrupos de análisis de la población como edad materna, edad fetal y se analizan los datos mediante porcentajes y promedios. Resultados: el promedio de edad materna fue de 25,9 años, el promedio de edad gestacional fue de 28,9 semanas. Se conoció el tipo de muerte en el 87,96% de los casos. Las causas más frecuentes de muerte fueron la hipoxia fetal intrínseca 46,67%: insuficiencia placentaria 17,5%, desprendimiento placentario 6,6%, infarto placentario 6,3%, HTA materna 4,5%. Anomalías congénitas 18,07%, infección bacteriana ascendente 16,26%, causa desconocida 12,04%. En gestaciones entre 20-29 semanas la principal causa de muerte fue patología placentaria (43.97%); en cuanto a 37-42 semanas la principal causa fue las anomalías congénitas (5,1%). Conclusiones: el presente estudio muestra que las principales causas de óbito fetal están vinculadas con patologías que pueden ser detectadas y manejadas de manera adecuada y expone la importancia de la autopsia fetal sumado al estudio anatomopatologico de la placenta a la hora de determinar dichas causas.

Management of hemodynamically unstable pelvic fracture in pregnancy: a case report and review of literature

We present an unusual case of an unstable pelvic fracture during pregnancy period, who suffered fetal death and splenic rupture simultaneously which developed massive delayed hemorrhage in abdomen. When considering potential causes of fetal death, direct trauma to the uterus, placenta, or fetus was not associated with a higher fetal mortality rate, compared with maternal hemorrhage. A cesarean section and splenectomy could rescue the maternal life from the hemorrhage situation. Successful treatment of these rare cases is possible with careful pre-, peri-, and post-operative evaluation of the mother and fetus by a multidisciplinary team.

Fetal Autopsy: A Review

Fetal autopsy helps to arrive at an accurate diagnosis in case of fetal demise. It also enables the clinician to assess the recurrence risk of an adverse maternal outcome and thereby, provide proper genetic counselling to the affected parents. Despite the emergence of many advanced imaging techniques, many studies suggest that fetal autopsy holds its ground as the standard way to interpret the cause of fetal death. The procedure and guidelines followed for fetal autopsy play a great role in influencing the outcome. Hence, the protocol for a fetal autopsy is being described in this article. This article highlights the types of fetal perinatal autopsy; the legal prerequisites for a medicolegal and academic autopsy; the standard procedure of a fetal autopsy; and the comparison of efficacy of imaging techniques and autopsy to make a diagnosis of the cause of fetal loss, still birth and neonatal death.

The Immune System in Foetal Death After a Spider Bite: Case Report with Literature Review

Loxoscelism is caused by the bite of a spider belonging to any of the Loxosceles species. We analyse the case of a pregnant woman, 35 weeks into gestation, who was accidentally bitten by a Loxosceles rufescens, in June 2015. She was treated with corticosteroids and antihistamines. After 36 hours of the bite, the patient went to Hospital having felt a lack of foetal movements. Foetal death was diagnosed and the woman was admitted for induction of labour. The autopsy stated as the cause of foetal death to be the presence of umbilical vein thrombosis and sub-funicular placental infarction. We propose that the activation of the thrombosis, in the case of this pregnancy was triggered by events linked directly with the venom of the spider. This venom possesses chemical components sufficient to activate the complement cascade which is closely linked to the coagulation system, and indirectly affected by the inflammation of the allergic response in a previously sensitized patient.

Uterine and placenta characteristics during early vascular development in the pig from day 22 to 42 of gestation

Insufficient placenta development is one of the primary causes of fetal death and reduced fetal growth after 35 days of gestation. Between day 22 and 42 the placenta consists of a central highly vascular placenta (HVP), adjacent to the fetus, a less vascular placenta (LVP), on either side of the fetus, and necrotic tips (NT). The objective of this study was to comprehensively evaluate uterine–placenta characteristics during early gestation in the gilt and determine time points and physiological changes. Gilts (n=25) were artificially inseminated at first detection of estrus (day 0) and 24h later, and harvested at 22, 27, 32, 37 or 42 days of gestation. Litter size, 12.1±3.4, was similar for all days of gestation. Fetal and placenta weight increased with day of gestation. The greatest increase in placenta weight occurred between 37 and 42 days of gestation. The LVP zones had no measurable fold formation until day 27. Necrotic tips became apparent after 27 days of gestation. Unoccupied areas of the uterus developed folds with changes in endometrial cell size and morphology from day 32 to 42 of gestation. Limited changes occurred in either fetal growth or placenta weight from day 27 through 32 of gestation; however, significant morphological changes occur at the maternal–fetal interface, demonstrating the dynamic architecture of the developing porcine placenta during early gestation. This work establishes fundamental time points in placenta development corresponding to fetal growth and microfold formation that may influence fetal growth and impact fetal survival.

Implications for Improving Fetal Death Vital Statistics: Connecting Reporters' Self-Identified Practices and Barriers to Third Trimester Fetal Death Data Quality in New York City.

Perinatal mortality prevention strategies that target fetal deaths often utilize vital records data sets shown to contain critical quality deficiencies. To understand the causes of deficient data, we linked survey responses of fetal death reporters with facility fetal death data quality indicators. In 2011, we surveyed the person most responsible for fetal death reporting at New York City healthcare facilities on their attitudes, barriers, and practices regarding reporting. We compared responses by 2 facility data quality indicators (data completeness and ill-defined cause of fetal death) for third trimester fetal death registrations using Chi squared tests. Thirty-nine of 50 facilities completed full questionnaires (78 % response rate); responding facilities reported 84 % (n = 11,891) of all 2011 fetal deaths, including 329 third trimester fetal deaths. Facilities citing ≥1 reporting barrier were approximately five times more likely to have incomplete third trimester registrations than facilities citing no substantial barriers (37.5 vs 7.9 %; RR 4.7; 95 % CI [1.6-14.2]). Reported barriers included onerous reporting requirements (n = 10; 26 %) and competing physician priorities (n = 11; 28 %). Facilities citing difficulty involving physicians in reporting were more likely to report fetal deaths with nonspecific cause-of-death information (70.9 vs 56.6 %; RR 1.3; 95 % CI [1.1-1.5]). Self-reported challenges correlate with completeness and accuracy of reported fetal death data, suggesting that such barriers are likely contributing to low quality data. We identified several improvement opportunities, including in-depth training and reducing the information collected, especially for early fetal deaths (<20 weeks' gestation), the majority of events reported.

Maternal prepregnancy obesity and cause-specific stillbirth

In high-income countries, maternal obesity is one of the most important modifiable causes of stillbirth, yet the pathways underpinning this association remain unclear. We estimated the association between maternal prepregnancy body mass index (BMI) and the risk of stillbirth defined by pathophysiologic contributors or causes. Using a case-cohort design, we randomly sampled 1829 singleton deliveries from a cohort of 68,437 eligible deliveries at Magee-Womens Hospital in Pittsburgh, Pennsylvania (2003-2010), and augmented it with all remaining cases of stillbirth for a total of 658 cases. Stillbirths were classified based on probable cause(s) of death (maternal medical conditions, obstetric complications, fetal abnormalities, placental diseases, and infection). A panel of clinical experts reviewed medical records, placental tissue slides and pathology reports, and fetal postmortem reports of all stillbirths. Causes of fetal death were assigned by using the Stillbirth Collaborative Research Network Initial Causes of Fetal Death protocol from the Eunice Kennedy Shriver National Institute of Child Health and Human Development. Proportional hazards models were used to estimate the BMI-stillbirth association after adjustment for confounders. The rate of stillbirth among lean, overweight, obese, and severely obese women was 7.7, 10.6, 13.9, and 17.3 per 1000 live-born and stillborn infants, respectively. Adjusted stillbirth HRs (95% CIs) were 1.4 (1.1, 1.8) for overweight, 1.8 (1.3, 2.4) for obese, and 2.0 (1.5, 2.8) for severely obese women, respectively, compared with lean women; associations strengthened when limited to antepartum stillbirths. Obesity and severe obesity were associated with stillbirth resulting from placental diseases, hypertension, fetal anomalies, and umbilical cord abnormalities. BMI was not related to stillbirth caused by placental abruption, obstetric conditions, or infection. Multiple mechanisms appear to link obesity to stillbirth. Interventions to reduce stillbirth among obese mothers should consider targeting stillbirth due to hypertension and placental diseases-the most common causes of fetal death in this at-risk group.

Direct Amplification of B1 gene of Toxoplasma gondii DNA using Nested Polymerase Chain Reaction Following Microwave Treatment for Whole Blood Samples

Infection with Toxoplasma gondii is a cause of fetal death since T. gondii can be transmitted to the fetus through the placenta (transplacental) from an infected mother or at vaginal delivery. Blood obtained from women and sheep to confirm their infection with toxoplasmosis by using Enzyme Linked Immunosorbant Assay test (ELISA) to ditective positive specific anti-Toxoplasma (IgM, IgG and IgM, or IgG) antibodies. This study used two methodes to extract DNA (the first one was a standard extraction commercial method (CM-PCR) of genomic DNA using a commercial kit (Promega, USA), and the second one was the direct heat DNA extraction using microwave oven (MW-PCR) for whole blood samples obtained from infected women and sheep. Then nested Polymerase Chain Reaction (n PCR) were used to amplify Toxoplasma B1 gene to detect T. gondii DNA in whole blood samples. The results indecated using of microwave treatment instead of commercial kit to extract DNA is low cost and short time,and complement serology for clinical studies and diagnostic purposes of toxoplasmosis.

Stillbirths in Germany: Retrospective Analysis of 168 Cases between 2003 and 2011

The decline in the incidence of stillbirths in Germany has remained static in recent years. This study aims to analyse the current situation of data documentation and examination of stillbirths. Furthermore, possible stillbirth prevention strategies should be developed. Searches in the international peer-reviewed literature, retrospective data collection of 168 stillbirths in 8 hospitals, (in the area of Bonn) with subsequent statistical evaluation (descriptive statistics, t-test and binominal test) were undertaken. This study shows considerable deficits in data documentation, interdisciplinary communication and postmortal examination. Only in 51.8% (87/168) of the cases was a certain or uncertain cause of death found (42.3% placental, 1.2% foetal, 3.6% chromosomal, 4.8% umbilical cord abnormalities). Severe foetal growth restriction (<5(th) percentile) was observed in 29.2%; 44.9% (22/49) of them died at the age of ≥36+0 weeks of gestation. The first step to reduce the rate of stillbirths in Germany is to increase the identified causes of foetal death: Therefore, an interdisciplinary case report form was compiled to improve data collection and interdisciplinary collaboration. To standardise and complete postmortal management, an algorithm was created. The long-term aim is the development of a central data register for statistical analysis, to identify goals of research and to organise conferences with interdisciplinary reports of diagnostic findings.

Stillbirth in an Anglophone minority of Canada

We assessed trends in stillbirth over time for Francophones and Anglophones of Quebec, a large Canadian province with publically funded health care and an English-speaking minority. We calculated stillbirth rates for Francophones and Anglophones, and estimated hazard ratios (HR) by decade from 1981 to 2010, adjusting for maternal characteristics. We analyzed temporal trends by gestational interval and cause of fetal death. Stillbirth rates decreased in Quebec during the three decades, due to improved rates in Francophones. Rates decreased for Anglophones in 1991-2000, but increased in 2001-2010 at term, during the second trimester, and for most causes of fetal death. In the 2000s, the hazard of stillbirth for Anglophones was nearly the same as the hazard for Francophones in the 1980s (HR 0.93, 95 % confidence interval 0.82, 1.05). Stillbirth rates declined in both Francophones and Anglophones before the turn of the century, but increased thereafter for Anglophones, suggesting that linguistic inequalities in stillbirth may be emerging in Quebec. Linguistic status may be a useful marker for surveillance of inequalities in stillbirth.

Sero-prevalence and risk factors of hepatitis C virus infection among pregnant women in Bahir Dar city, Northwest Ethiopia: cross sectional study.

Viral hepatitis during pregnancy is associated with high risk of maternal complications and has become a leading cause of fetal death. So the main objective of this study is to determine the prevalence of hepatitis C viral infections among pregnant women attending the antenatal clinic in Bahir Dar health institutions, Ethiopia. This was institutional based cross-sectional study that included 318 pregnant women who attended the antenatal clinic in Bahir Dar health institutions from January 2013 to June 2013. Appropriate data was gathered from study participants. Sero-prevalence of hepatitis C virus was determined by detecting immunoglobulin of HCV using ELISA kit. Data was entered and analyzed with SPSS version 16 statistical software. The overall prevalence of hepatitis C virus among pregnant women was 0.6%. None of the expected risk factors had significant outcome. In conclusion, prevalence of the Hepatitis C virus among pregnant women attending in Bahir Dar health institutions was low and expected variables were not statistically significant.

Association of Histophilus somni with spontaneous abortions in dairy cattle herds from Brazil.

This study investigated the participation of infectious agents in spontaneous abortions and reproductive problems at eight dairy cattle herds from three geographical regions of Brazil. Fourteen aborted fetuses and the organ sections of one cow with history of repeated abortions were received for pathological evaluations and molecular diagnostics. PCR/RT-PCR assays targeted specific genes of abortifacient agents of cattle: bovine viral diarrhea virus (BVDV), bovine herpesvirus 1 (BoHV-1), Listeria monocytogenes, Neospora caninum, Leptospira spp., Brucella abortus, and Histophilus somni. Six fetuses were adequate for pathological investigations; one of these did not demonstrate remarkable pathological alterations. Significant histopathological findings included vasculitis, hemorrhage, and fibrinous thrombosis of the cerebrum (n = 4); necrotizing myocarditis (n = 3); and hemorrhagic enteritis (n = 3). The placenta and uterus of the cow as well as the kidney, pancreas, and liver of her aborted fetus contained H. somni DNA and demonstrated histopathological evidence of histophilosis. All fetuses contained H. somni DNA in multiple organs. Coinfections of H. somni with B. abortus (n = 2), N. caninum (n = 2), BVDV (n = 1), and BoHV-1 (n = 1) were identified; two fetuses demonstrated three pathogens. These findings suggest that H. somni was associated with the spontaneous abortions and reproductive problems of these herds. However, the exact cause of fetal death might not be attributed only to H. somni in all aborted fetuses, since some of these were infected with other abortifacient agents.

The investigation of the role of proteoglycans and ADAMTS levels in fetal membranes in physiopathological process of gestational diabetes

About 2–5% of all pregnant women develop gestational diabetes mellitus (GDM) during pregnancy and its prevalence has increased markedly within the last decade. GDM is a metabolic syndrome produced by various degrees of carbohydrate intolerance during pregnancy. Various risk factors such as obesity, genetics, environmental factors, and hypertension have been described previously. Maternal and fetal complications occur in around 7% of pregnant women with GDM. In these patients, a relation between proteoglycans and ADAMTS proteases located in extracellular matrix in fetal membranes (placenta, cord, amnion) and complicated pregnancies has already been determined by various animal experiments. Changes in expression, structure and function of ADAMTS proteases and proteoglycans in fetal membranes lead to alteration in the structure of extracellular matrix. If we can establish a balance between these proteoglycans and ADMTS proteases or determine the changes in their structure and functions, it will be possible to predict the risk in high risk pregnancies at early weeks and to initiate treatment early or to follow the target population regularly. In addition, prevention or reduction of maternal and fetal complications may be possible. For this purpose, ADAMTS and proteoglycans the synthesis of which is too much or less, may be targeted and if we would be able to determine and prevent the changes in their levels in the early period of pregnancy, the development of GDM and its complications may be prevented or decreased. Thus, we may identify a marker for early diagnosis and treatment and reduce prematurity, which is the most common cause of fetal death. Fetal and maternal complications, and especially treatment and care costs of prematurity, may also be decreased.

Placental pathology, perinatal death, neonatal outcome, and neurological development: a systematic review.

BackgroundThe placenta plays a crucial role during pregnancy for growth and development of the fetus. Less than optimal placental performance may result in morbidity or even mortality of both mother and fetus. Awareness among pediatricians, however, of the benefit of placental findings for neonatal care, is limited.ObjectivesTo provide a systematic overview of the relation between placental lesions and neonatal outcome.Data sourcesPubmed database, reference lists of selected publications and important research groups in the field.Study appraisal and synthesis methodsWe systematically searched the Pubmed database for literature on the relation between placental lesions and fetal and neonatal mortality, neonatal morbidity and neurological outcome. We conducted three separate searches starting with a search for placental pathology and fetal and neonatal mortality, followed by placental pathology and neonatal morbidity, and finally placental pathology and neurological development. We limited our search to full-text articles published in English from January 1995 to October 2013. We refined our search results by selecting the appropriate articles from the ones found during the initial searches. The first selection was based on the title, the second on the abstract, and the third on the full article. The quality of the selected articles was determined by using the Newcastle-Ottawa Quality Assessment Scale.ResultsPlacental lesions are one of the main causes of fetal death, where placental lesions consistent with maternal vascular underperfusion are most important. Several neonatal problems are also associated with placental lesions, whereby ascending intrauterine infection (with a fetal component) and fetal thrombotic vasculopathy constitute the greatest problem.ConclusionsThe placenta plays a key role in fetal and neonatal mortality, morbidity, and outcome. Pediatricians should make an effort to obtain the results of placental examinations.

Understanding Perinatal Death: A Systematic Analysis of New York City Fetal and Neonatal Death Vital Record Data and Implications for Improvement, 2007–2011

We aimed to compare demographic, medical, and cause-of-death information reported for third-trimester fetal and neonatal death vital records collected in New York City (NYC) before and after implementation of the revised fetal death certificate to identify: (1) the limitations of combining fetal and neonatal death records for the purpose of perinatal death prevention; and (2) improvement opportunities for fetal death vital records registration. Using Chi squared tests, we compared data completeness and cause-of-death information between third-trimester NYC fetal (n = 1,930) and neonatal deaths (n = 735) from 2007 to 2011. We also compared fetal death data before and after the 2011 implementation of the 2003 United States (US) Standard Report of Fetal Death and an electronic reporting system. Compared with neonatal deaths, fetal death data were generally less complete (P < 0.0001). Fetal death data much more frequently reported an ill-defined cause of death (67 vs. 5 %). Most ill-defined reported causes of fetal death (73 %) were attributed to stillbirth synonyms (e.g., "fetal demise"). Ill-defined causes of fetal death decreased from 68 to 61 % (P < 0.01) after 2011. Both data completeness and ill-defined causes of death varied widely by hospital. In NYC, fetal deaths lack demographic, medical, and cause-of-death information compared with neonatal deaths, with implications for research that uses combined perinatal mortality data sets. Electronic implementation of the US Standard Report of Fetal Death minimally improved cause-of-death information. Substantial variability by hospital suggests opportunities for improvement exist.