Delivery-related Perinatal Death Research Articles

Management of Breech Presentation: Green-top Guideline No. 20b.

Management of Breech Presentation: Green-top Guideline No. 20b.

Birth weight percentile and the risk of term perinatal death.

To estimate the association between birth weight percentile and the risk of perinatal death at term in relation to the cause of death. We performed a retrospective cohort study of all term singleton births in delivery units in Scotland between 1992 and 2008 (n=784,576), excluding perinatal deaths ascribed to congenital anomaly. There were 1,700 perinatal deaths in the cohort, which were not the result of congenital anomaly (21.7/10,000 women at term). We observed a reversed J-shaped association between birth weight percentile and the risk of antepartum stillbirth in all women, but the associations significantly differed (P<.001) according to smoking status. The highest risk (adjusted odds ratio referent to 21st-80th percentile, 95% confidence interval) among nonsmokers was for birth weight third or less percentile (10.5, 8.2-13.3), but there were also positive associations for birth weight percentiles 4th-10th (3.8, 3.0-4.8), 11th-20th (1.9, 1.5-2.4), and 98th-100th (1.8, 1.3-2.4). Among smokers, the associations with being small were weaker and the associations with being large were stronger. We also observed a reversed J-shaped association between birth weight percentile and the risk of delivery-related perinatal death (ie, intrapartum stillbirth or neonatal death), but there was no interaction with smoking. The highest risk was for birth weight greater than the 97th percentile (2.3, 1.6-3.3), but there were also associations with third or less percentile (2.1, 1.4-3.1), 4th-10th (1.8, 1.4-2.4), and 11th-20th (1.5, 1.2-2.0). Analysis of the attributable fraction indicated that approximately one in three antepartum stillbirths and one in six delivery-related deaths at term could be related to birth weight percentile outside the range 21st-97th percentile. Effective detection of variation in fetal size at term has potential as a screening test for the risk of perinatal death. II.

Anesthesia Literature Review

Anesthesia Literature Review

Advanced maternal age and the risk of perinatal death due to intrapartum anoxia at term

BackgroundAdvanced maternal age is associated with higher risks of intrapartum complications. However, the effect of maternal age on the risk of perinatal death due to these complications is unclear. The...

Rates of and Factors Associated With Delivery-Related Perinatal Death Among Term Infants in Scotland

Rates of and Factors Associated With Delivery-Related Perinatal Death Among Term Infants in Scotland

Rates of and Factors Associated With Delivery-related Perinatal Death Among Term Infants in Scotland

Context Rates of obstetric intervention in labor, including cesarean delivery, have increased significantly in most developed countries. It is, however, unclear if this has been paralleled by decreased rates of perinatal and neonatal death associated with complications of labor at term. Objectives To determine whether rates of perinatal death at term, either during labor or in the neonatal period, have changed in Scotland during the last 20 years and whether this was associated with a reduction in deaths ascribed to intrapartum anoxia. Design, Setting, and Participants A population-based, retrospective cohort study of linked data from a registry of births (Scottish Morbidity Record 02) and a registry of perinatal deaths (Scottish Stillbirth and Infant Death Survey) between 1988 and 2007. Participants included all births of a singleton infant in a cephalic presentation at term (N = 1 012 266), excluding those with perinatal death due to congenital anomaly or antepartum stillbirth. Main Outcome Measure Delivery-related perinatal death, defined as intrapartum stillbirth or neonatal death unrelated to congenital abnormality. These events were also subdivided into those events ascribed to intrapartum anoxia and all other causes. The risk of death was modeled using logistic regression and analyses were adjusted for maternal age, height, parity, socioeconomic deprivation status, gestational age, birth weight percentile, fetal sex, onset of labor, and the annual number of births per hospital. Results During the study period, the risk of delivery-related perinatal death decreased from 8.8 to 5.5 per 10 000 births (unadjusted change, −38%; 95% confidence interval [CI], −51% to −21%). When analyzed by the cause of death, there was a significant decrease in the risk of death ascribed to intrapartum anoxia (5.7 to 3.0 per 10 000 births; unadjusted change, −48%; 95% CI, −62% to −29%), but no significant change in the risk of death ascribed to other causes. When deaths ascribed to intrapartum anoxia were analyzed by the time of death in relation to delivery, the reduction was similar comparing intrapartum stillbirths (2.6 to 1.1 per 10 000 births; unadjusted change, −60%; 95% CI, −75% to −34%) and neonatal deaths (3.1 to 1.9 per 10 000 births; unadjusted change, −38%; 95% CI, −59% to −7%). Adjustment for maternal, fetal, and obstetric factors was without material effect. Conclusion Rates of intrapartum stillbirth and neonatal death at term decreased in Scotland between 1988 and 2007. This decrease was only significant for deaths ascribed to intrapartum anoxia.

Rates of and Factors Associated With Delivery-Related Perinatal Death Among Term Infants in Scotland

It is unclear whether the marked increase of cesarean deliveries and other obstetric intervention in recent years has reduced the rates of perinatal and neonatal death associated with intrapartum anoxia or other complications of labor at term. Two previous studies reported that the rates of intrapartum stillbirths attributable to anoxia were reduced but both had methodological and other deficiencies. The aim of this population-based, retrospective cohort study was to determine whether rates of delivery-related perinatal death at term changed over a 20-year period in Scotland and whether there has been a reduction in deaths ascribed to intrapartum anoxia. Data were linked from a registry of births (Scottish Morbidity Record 02) and a registry of perinatal deaths (Scottish Stillbirth and Infant Death Survey) for singleton births between 1988 and 2007. All singleton infants (n = 1,012,266) were delivered at term in a cephalic presentation. Exclusion criteria were antepartum stillbirth or perinatal death due to congenital abnormality. The characteristics of deaths due to intrapartum anoxia were compared with those ascribed to all other causes. Unadjusted logistic regression analysis showed that the risk of delivery-related perinatal death during the study period decreased from 8.8 to 5.5 per 10,000 births; the percentage change was -38%, with a 95% CI of -51% to -21%. With unadjusted analysis according to cause of death, a statistically significant decrease was found in the incidence of death ascribed to intrapartum anoxia from 5.7 to 3.0 per 10,000 births (percentage change, -48%; 95% CI, -62% to -29%), whereas no statistically significant decrease was found in the incidence of death due to other causes (from 3.1 to 2.5 per 10,000 births; percentage change, -19%; 95% CI, -45% to 19%). The unadjusted data showed a comparable decrease in the incidence of deaths ascribed to intrapartum anoxia for intrapartum stillbirth (2.6 to 1.1 per 10,000 births; percentage change, -60%; 95% CI, -75% to -34%) and neonatal death (3.1 to 1.9 per 10,000 births; percentage change, -38%; 95% CI, -59% to -7%). Adjustment for measured changes in maternal, fetal, or obstetric characteristics did not affect the results. These findings demonstrate a reduction in the incidence of intrapartum stillbirth and neonatal deaths over a 20-year period in Scotland. The rate of decrease was significant only for deaths associated with intrapartum anoxia.

Perinatal mortality and severe morbidity in low and high risk term pregnancies in the Netherlands: prospective cohort study

Objective To compare incidences of perinatal mortality and severe perinatal morbidity between low risk term pregnancies supervised in primary care by a midwife and high risk pregnancies supervised in secondary...

Rates of and factors associated with delivery-related perinatal death among term infants in Scotland.

Rates of obstetric intervention in labor, including cesarean delivery, have increased significantly in most developed countries. It is, however, unclear if this has been paralleled by decreased rates of perinatal and neonatal death associated with complications of labor at term. To determine whether rates of perinatal death at term, either during labor or in the neonatal period, have changed in Scotland during the last 20 years and whether this was associated with a reduction in deaths ascribed to intrapartum anoxia. A population-based, retrospective cohort study of linked data from a registry of births (Scottish Morbidity Record 02) and a registry of perinatal deaths (Scottish Stillbirth and Infant Death Survey) between 1988 and 2007. Participants included all births of a singleton infant in a cephalic presentation at term (N = 1,012,266), excluding those with perinatal death due to congenital anomaly or antepartum stillbirth. Delivery-related perinatal death, defined as intrapartum stillbirth or neonatal death unrelated to congenital abnormality. These events were also subdivided into those events ascribed to intrapartum anoxia and all other causes. The risk of death was modeled using logistic regression and analyses were adjusted for maternal age, height, parity, socioeconomic deprivation status, gestational age, birth weight percentile, fetal sex, onset of labor, and the annual number of births per hospital. During the study period, the risk of delivery-related perinatal death decreased from 8.8 to 5.5 per 10,000 births (unadjusted change, -38%; 95% confidence interval [CI], -51% to -21%). When analyzed by the cause of death, there was a significant decrease in the risk of death ascribed to intrapartum anoxia (5.7 to 3.0 per 10,000 births; unadjusted change, -48%; 95% CI, -62% to -29%), but no significant change in the risk of death ascribed to other causes. When deaths ascribed to intrapartum anoxia were analyzed by the time of death in relation to delivery, the reduction was similar comparing intrapartum stillbirths (2.6 to 1.1 per 10,000 births; unadjusted change, -60%; 95% CI, -75% to -34%) and neonatal deaths (3.1 to 1.9 per 10,000 births; unadjusted change, -38%; 95% CI, -59% to -7%). Adjustment for maternal, fetal, and obstetric factors was without material effect. Rates of intrapartum stillbirth and neonatal death at term decreased in Scotland between 1988 and 2007. This decrease was only significant for deaths ascribed to intrapartum anoxia.

Intrapartum deaths: missed opportunities

Although fetal and perinatal death remains a common event in obstetric practice, only a minority of these deaths occur during, or as a consequence of, events during labour or delivery. Unfortunately, many of these deaths are associated with substandard care. In some cases, avoidance of labour altogether, with delivery by Caesarean section, will prevent such adverse events and these risk factors can be determined antenatally. For most women, ostensibly ‘low-risk’ for such problems at the onset of labour, good midwifery and obstetric care, with the judicious use of fetal monitoring and intervention when concerns arise, are the cornerstone of avoiding delivery-related perinatal death. In this review we examine risk factors for delivery-related perinatal death and consider how such tragedies could hopefully be avoided.

Vaginal birth after Caesarean section: a practical evidence-based approach

Around 10% of the obstetric population have experienced prior Caesarean delivery. This article provides a practical evidence-based approach to the antenatal and intrapartum management of such women. A gestation-specific strategy is suggested. Women with an uncomplicated pregnancy and single previous lower segment Caesarean delivery may be managed in shared community care following counselling by a consultant midwife. It is important to provide complete informed consent detailing the risks and benefits for the woman that are individualised to her circumstances. It is estimated that planned vaginal birth after Caesarean exposes the woman to an additional 0.25% risk (or 1 in 400) for experiencing an adverse perinatal outcome (antepartum stillbirth, delivery-related perinatal death or hypoxic ischaemic encephalopathy) compared with opting for elective repeat Caesarean section (ERCS). It is likely that this risk is significantly reduced for women who opt for ERCS at the start of the 39th week; however, direct evidence to support this is lacking.

Time trend in the risk of delivery-related perinatal and neonatal death associated with breech presentation at term

To determine the factors associated with the risk of delivery-related perinatal and neonatal death among term infants presenting by the breech and the effect of changes in the mode of delivery on the overall rates of perinatal and neonatal mortality associated with breech presentation. We studied 32,776 singleton term infants presenting breech excluding anomalous and antepartum losses in Scotland between 1985 and 2004, using linked Scottish national registries of pregnancy outcome data and perinatal death data. The event was delivery-related perinatal and neonatal death (i.e. intrauterine fetal death during labour or death of infant in the first 4 weeks of life), subdivided according to intrapartum anoxia or mechanical cause of death. Analysis was by multivariate logistic regression. During the study period, the risk of delivery-related perinatal and neonatal death decreased by 72% (95% CI -1% to 93%), due to a 90% (95% CI 33-99%) reduction in anoxic or mechanical deaths. Both intrapartum (OR 0.16, 95% CI 0.02-0.75) and planned (OR 0.01, 95% CI 0.00-0.09) caesarean delivery were protective against anoxic or mechanical deaths and increased use of planned caesarean delivery accounted for 16% of the decline in anoxic and mechanical deaths over the study period. Increased use of planned caesarean delivery only partly explains the decline in delivery-related perinatal and neonatal death between 1985 and 2004 in Scotland.

80: Longitudinal study of the risk of delivery related perinatal death associated with breech presentation at term

We sought to characterize the factors associated with the risk of delivery-related perinatal death (PND) among term infants presenting by the breech and the effect of changes in the mode of delivery on overall rates of PND associated with breech presentation.

650: Reduced rates of delivery-related perinatal death at term in Scotland, 1985-2004 are due to improved obstetric care

650: Reduced rates of delivery-related perinatal death at term in Scotland, 1985-2004 are due to improved obstetric care

Birth order of twins and the risk of delivery related perinatal death in England, Northern Ireland and Wales, 1994-2003

Birth order of twins and the risk of delivery related perinatal death in England, Northern Ireland and Wales, 1994-2003

Birth Order, Gestational Age, and Risk of Delivery Related Perinatal Death in Twins: Retrospective Cohort Study

There is wide agreement that second twins are at increased risk of complications during labor and delivery, but large-scale observational studies going back to the 1960s disagree about the perinatal mortality risk. The present retrospective cohort study linked a national register of data on post-childbirth discharges with a register of perinatal deaths occurring in Scotland in the years 1992-1997. The study group included 4545 women who delivered twins at or after 24 weeks' gestation, 15% of whom had cesarean delivery. On univariate analysis the only independent predictors of preterm birth were parity and maternal height. Deaths of first and second twins born before 36 weeks' gestation did not differ significantly. After 36 weeks, however, there were no deaths of first twins but nine among second twins (risk ratio, 3.7; P =.004). The discordance between first and second twins was significantly different for preterm and term births. Five of the nine second-twin deaths at term were intrapartum stillbirths, and four were neonatal deaths. Intrapartum anoxia was considered responsible for all but two deaths. In six of seven term deliveries in which the second twin died of anoxia, and in all five of these deliveries where anoxia had a mechanical obstetrical origin, both twins were delivered vaginally. There were no delivery-related perinatal deaths among 454 twin pairs delivered at term by planned cesarean section. Birth-weight discrepancies between twin infants were significantly greater when the second twin died than when both twins survived. On multivariate logistic regression analysis, the relationship between birth order and gestational age was independent of maternal age, parity, smoking, height, and socioeconomic status. These findings suggest that second twins born at term are likelier than their first twin partners to die of complications relating to vaginal delivery. Planned cesarean delivery may protect against these deaths, and women bearing twins should be told this when deciding on mode of delivery.

Birth order, gestational age, and risk of delivery related perinatal death in twins: retrospective cohort study

Objective: To determine whether twins born second are at increased risk of perinatal death because of complications during labour and delivery.Design: Retrospective cohort study.Setting: Scotland, 1992 and 1997.Participants: All twin...