Early Neonatal Death Research Articles

Risk Factors for Early Neonatal Death despite Cesarean Section

Objective: To identify the risk factors for early neonatal death (NND) despite cesarean section (CS). Methods: This case-control study was carried out between 1st February and 31st May, 2019. Files of women whose newborns died within seven days following CS and those of women whose newborns were alive seven days after CS were examined. The main variables recorded included maternal age, educational level, gestational age at delivery, number of antenatal visits done, whether the woman was referred or not, intrapartum fever or hemorrhage, indication of CS, decision delivery interval, birthweight and sex of newborn. Data were analyzed using SPSS 21.0. Fisher exact test, t-test and logistic regression were used for comparison. P<0.05 was considered statistically significant. Results: Our frequency of NND after CS was 4.8% (51/1053). Significant risk factors for NND after CS were birth weight <2000g (aOR 48.18, 95%CI 12.97-152.21), intra-partum hemorrhage (aOR 12.15, 95%CI 5.77-25.97), intra-partum fever (aOR 5.64, 95%CI 1.81-17.66), ˂4 antenatal visits (aOR 4.13, 95%CI 2.71-6.74), arrival ˃1h after referral (aOR 3.09, 95%CI 1.67-5.71) and primary school education level (aOR 2.39, 95%CI 1.16-4.92). Conclusion: From the risk factors identified above, we can recommend that women, especially those with primary school education level, should be counselled to attend at least four antenatal visits to allow the diagnosis and treatment of some diseases. Moreover, CS should be carried out as fast as possible in the cases of intrapartum hemorrhage. Women with intrapartum fever needs particular attention. Lastly, referral should be organized so that the woman arrives earlier.

Fetomaternal hemorrhage: Evidence from a multihospital healthcare system that up to 40% of severe cases are missed.

We previously reported fetomaternal hemorrhage (FMH) in 1/9160 births, and only one neonatal death from FMH among 219,853 births. Recent reports indicate FMH is not uncommon among stillbirths. Consequently, we speculated we were missing cases among early neonatal deaths. We began a new FMH initiative to determine the current incidence. We analyzed births from 2011 to 2020 where FMH was diagnosed. We also evaluated potential cases among neonates receiving an emergent transfusion just after birth, whose mothers were not tested for FMH. Among 297,403 births, 1375 mothers were tested for FMH (1/216 births). Fourteen percent tested positive (1/1599 births). Of those, we found 25 with clinical and laboratory evidence of FMH adversely affecting the neonate. Twenty-one received one or more emergency transfusions on the day of birth; all but two lived. We found 17 others who received an emergency transfusion on the day of birth where FMH was not tested for, but was likely; eight of those died. The 42 severe (proven + probable) cases equate to 1/7081 births. We judged that 10 of the 42 had an acute FMH, and in the others it likely had more than a day before birth. We estimate that we fail to diagnose >40% of our severe FMH cases. Needed improvements include (1) education to request maternal FMH testing when neonates are born anemic, (2) education on false-negative FMH tests, and (3) improved FMH communications between neonatology, obstetrics, and blood bank.

Lethality of Birth Defects in Live Born Infants Categorized by Gestational Age and Birth Weight.

This study aimed to describe lethality of birth defects (BDs) in newborns categorized by gestational age and birth weight and to identify BDs associated with prematurity. Live born infants (n = 16,452) with isolated BDs classified by severity, and 42,511 healthy controls were assigned to categories: adequate growth, preterm, or small for gestational age (SGA). Proportion of cases and BDs' lethality rates were obtained by category and compared with controls. Overall fewer malformed than nonmalformed infants were of adequate growth, while the opposite occurred in the preterm and SGA categories where gastroschisis and esophageal atresia were among the most outstanding defects. For most severe BDs, the early neonatal death rate was higher than control values in all categories; for mild defects, except cleft lip in the preterm category, they did not differ. Diaphragmatic hernia showed the highest lethality values, while those of spina bifida were among the lowest. Talipes, hypospadias, and septal heart defects were mild defects significantly associated with prematurity. Although reasons, such as induced preterm delivery of fetuses with certain anomalies, could partially account for their high prematurity rates, susceptibility to preterm birth might exist through underlying mechanisms related with the defects. The identification of BDs associated with prematurity should serve to improve measures that prevent preterm birth especially of fetuses at risk. · Some BDs predispose to prematurity.. · Prematurity is an additional risk factor for mortality in infants with mild defects.. · Lethality values should be adjusted by gestational age and birth weight..

The burden of severe hypertensive disorders of pregnancy on perinatal outcomes: a nationwide case-control study in Suriname

BACKGROUNDLatin America and the Caribbean is the region with the highest prevalence of hypertensive disorders of pregnancy worldwide. In Suriname, where the stillbirth rate is the second highest in the region, it is not yet known which maternal factors contribute most substantially.OBJECTIVEThe aims of this study in Suriname were to (1) study the impact of different types of maternal morbidity on adverse perinatal outcomes and (2) study perinatal birth outcomes among women with severe hypertensive disorders of pregnancy.STUDY DESIGNA case-control study was conducted between March 2017 and February 2018 during which time all hospital births (86% of total) in Suriname were included. We identified babies with adverse perinatal outcomes (perinatal death or neonatal near miss) and women with severe maternal morbidity (according to the World Health Organization Near Miss tool). Stillbirths and early neonatal deaths (<7 days) were considered perinatal death. We defined a neonatal near miss as a birthweight below 1750 g, gestational age <33 weeks, 5-minute Apgar score <7, and preterm intrauterine growth restriction <p3. Descriptive statistics and multivariate binary logistic regression analyses were conducted.RESULTSIn the 1-year study period, adverse perinatal outcomes were reported for 638 singleton births of which 120 (18.8%) involved women with severe maternal morbidity. In most of these cases, the mother suffered severe hypertensive disorders of pregnancy (n=95/120, 79.2%). Severe hypertensive disorders of pregnancy were strongly associated with adverse perinatal outcomes (adjusted odds ratio, 11.1; 95% confidence interval, 8.3–14.9). The prevalence of severe hypertensive disorders of pregnancy in Suriname was 2.5% (234/9197). Of the 215 singleton pregnancies complicated by severe hypertensive disorders, adverse perinatal outcomes were reported for 44.2% of them (n=95/215; adjusted odds ratio, 11.1; 95% confidence interval, 8.3–14.9); perinatal death accounted for 18.1% of these cases (n=39/215; adjusted odds ratio, 8.6; 95% confidence interval, 5.8–12.7) and neonatal near miss accounted for another 26.0% (n=56/215). Women with severe hypertensive disorders of pregnancy had a preterm birth (<37 weeks) in 67.1% of the cases (n=143/215; adjusted odds ratio, 14.1; 95% confidence interval, 10.5–19.0), a baby with a low birthweight (<2500 g) in 62.2% of the cases (n=130/215; adjusted odds ratio, 10.8; 95% confidence interval, 8.1–14.5), and a baby with a low 5-minute Apgar score in 20.5% of the cases (n=43/215; adjusted odds ratio, 6.9; 95% confidence interval, 4.8–10.0).CONCLUSIONIn Suriname, severe hypertensive disorders of pregnancy are strongly associated with adverse perinatal outcomes, with an increased risk for preterm birth, low birthweight, low Apgar score, and perinatal mortality. Prevention, early diagnosis, and management of hypertensive disorders of pregnancy are expected to reduce perinatal deaths substantially. Recommendations to reduce perinatal deaths in Suriname include the establishment of a national health plan for the management of severe hypertensive disorders of pregnancy and the introduction of perinatal death and neonatal near miss reviews.

Contributing factors to perinatal mortality among women who gave birth at the Jimma University Medical Centre, southwest Ethiopia

Background Perinatal mortality remains a challenge worldwide, particularly in developing countries. Although significant achievements have been made to reduce neonatal mortality worldwide, in the last two decades there was a total of 5.3 million neonatal deaths and stillbirths each year. This study aims to assess the magnitude of perinatal mortality and its contributing factors among births at the Jimma University Medical Centre in Ethiopia. Method A facility-based cross-sectional study was conducted between January and April 2017. Convenience sampling was used to select study participants and data were collected using interviewer-administered pretested structured questionnaires. Descriptive statistics were used to analyse the data, with the chi-square test used to assess the relationship between each factor and outcome. Statistical significance was set at P&lt;0.05. Results The rate of perinatal death was 107 per 1000 births, of which 39.2%, 25.9% and 34.9% were fresh stillbirths, macerated stillbirths and early neonatal deaths respectively. The majority (77.8%) of stillbirths occurred before the study participant reached the hospital and 64.3% of stillbirths had low birth weight. Hyaline membrane disease (27.6%) and meconium aspiration syndrome (20.7%) were the two most common causes of early perinatal death. Obstetric complications contributed to 89.6% of perinatal deaths. Stillbirth was significantly associated with a lack of education (P=0.036). The rate of perinatal mortality was high among women with their first pregnancy (53.0%) and those who had no previous pregnancy-related problems (79.5%), and was significantly associated with mechanical causes and antepartum haemorrhage (P=0.015). Conclusions The findings indicated that the rate of perinatal mortality was high at the Himma University Medical Centre. Improving maternal education and health services in rural areas are important steps to prevent poor perinatal outcomes. Facilitating transport and improving referral procedures may help to prevent mechanical complications, which are the most common cause of perinatal death, particularly fresh stillbirths which, in the present study, often occurred before a participant arrived at the hospital.

Анализ причин ранней неонатальной смертности в Российской Федерации в 2020 г. (год пандемии COVID-19)

In March 2020, the World Health Organization declared a COVID-19 pandemic. The aim of this study was to compare the causes of and statistics on neonatal mortality in Russia in the years 2020 and 2019 using the Rosstat A-5 forms that aggregate data from perinatal death certificates. In 2020, there was a 7.6% reduction in the absolute number of live births relative to 2019. In 2020, the early neonatal death rate (1.59‰) fell by 4.4% relative to 2019 (1.67‰). But neonatal death rates in the Southern and Far Eastern Federal Districts rose by 20.5% and 6.1%, respectively. Respiratory diseases were the most common cause of early neonatal mortality across Russia (37.3% and 40.2% relative to the total number of neonatal deaths in 2019 and 2020, respectively). Congenital sepsis accounted for 43.6% and 46.6% of neonatal deaths from infectious diseases and for 7.3% and 7.9% of all neonatal deaths reported in 2019 and 2020, respectively. There was an increase in the proportion of respiratory diseases among neonates, including congenital pneumonia and other respiratory conditions, and infections, including congenital sepsis, which reflects the direct and indirect effects of SARS-CoV-2 infection in pregnant women and neonates.

Perinatal mortality trend and classification of causes at a tertiary care centre of western Nepal

Background: Identifying causes of perinatal death is important to reduce perinatal mortality rate. Objectives: To determine trend of perinatal mortality rate (PMR), ascertain causes, and find out changes in causes of death over period of seven years. Methods: This retrospective study, conducted after ethical approval, included stillbirths and early neonatal deaths at Manipal teaching hospital from April 2014 to April 2021, after 28 weeks of gestation or of foetuses weighing more than 1000 grams. Perinatal mortality rate of each year was calculated. Cause of death was assigned according to International Classification of Disease – Perinatal Mortality classification. Data analysis was done to find out trends and causes of perinatal mortality using SPSS v.21. Frequency and percentages were used to calculate causes of deaths. Results: Perinatal mortality rate decreased from 35.5 to 21.1 per 1000 births over seven years. Antepartum hypoxia (103, 45%) was commonest cause of antepartum deaths, commonly associated with maternal medical conditions. This remained as main cause of antepartum death over years. Acute intrapartum events resulted in three-fourths of intrapartum deaths; were associated with complications of labour and delivery. Decline in this has resulted in overall decrease in intrapartum deaths. Low birth weight and prematurity (73, 42.2%) was the common cause of neonatal deaths and has remained same over years. Conclusion: Perinatal mortality has decreased over years. Antepartum hypoxia as cause of antepartum deaths and prematurity as cause of neonatal deaths remained same over years. There is decrease in intrapartum deaths due to declining acute intrapartum events.

Intrauterine infection verification in neonatal mortality

Aim.To verify contribution of intrauterine infections to early neonatal mortality, using autopsy and molecular genetic findings.Materials and methods.The study was carried out at the premises of the Research Institute of Maternity and Childhood Protection and the Pathology Department of the Khabarovsk Perinatal Center. An analysis was made of the data on medical history, pregnancy course and outcome, morphological placental study in seven cases of early neonatal death. Genomes of Chlamydia trachomatis, Trichomonas vaginalis, Mycoplasma genitalium, Mycoplasma hominis, Ureaplasma species (Ureaplasma urealyticum + Ureaplasma parvum), Streptococcus agalactiae, Staphylococcus spp., Pseudomonas aeruginosa, Klebsiella pneumoniae, Haemophilus influenza, Listeria monocytogenes, Cytomegalovirus, Herpes simplex virus, Human herpesvirus type 4, and Human herpesvirus type 6 were detected by polymerase chain reaction (PCR) in samples of placental tissue.Results.Samples of six out of seven placentas (85.7%) in early neonatal death cases were found to present with genomes of opportunistic microorganisms, which are part of biocenosis of the woman’s urogenital tract and enter the placenta and the fetus by an ascending pathway (S. agalactiae, Ureaplasma spp., M. hominis), as well as genomes of opportunistic herpesviruses (Cytomegalovirus, Human herpesvirus type 6), which constantly persist and reproduce in human lymphocytes and are transmitted mainly by a transplacental route. Infectious and inflammatory changes in placenta and membranes resulting in respiratory disorders, fetal hypoxia and asphyxia were found in all cases of opportunistic pathogen detection.Conclusion.This is indicative of the ability of the said opportunistic organisms to contribute to the pathogenesis of neonatal death. Contribution of intrauterine infections to early neonatal death cases is made up of both congenital neonatal infection cases and cases of infectious and inflammatory processes in placenta and membranes leading to respiratory distress, the immediate cause of death.

Risk factors for stillbirth and early neonatal death: a case-control study in tertiary hospitals in Addis Ababa, Ethiopia

BackgroundEthiopia is a Sub-Saharan country that has made significant improvements in maternal mortality and under-five mortality over the past 15 years. However, the nation continues to have one of the highest rates of perinatal mortality in the entire world with current estimates at 33 deaths per 1000 live births.MethodsThis case-control study was conducted between October 2016 and May 2017 at Tikur Anbessa Hospital and Gandhi Memorial Hospital. All women who had a stillbirth or early neonatal death (i.e. death within 7 days) during this period willing to participate were included as cases. A systematic random sample of women delivering at the hospital were approached for recruitment as controls to generate a 2:1 ratio of controls to cases. Data on risk factors were retrieved from medical records including delivery records, and treatment charts. Statistical differences in background and social characteristics of cases and controls were determined by t-test and chi-squared (or fisher’s exact test) for quantitative and categorical variables respectively. Binary logistic regression analysis was completed to determine any associations between risk factors and stillbirth/early neonatal death.ResultsDuring the study period, 366 women delivering at the hospitals were enrolled as cases and 711 women delivering at the hospitals were enrolled as controls. Records from both hospitals indicated that the estimated stillbirth and neonatal mortality rates were 30.7 per 1000. Neonatal causes (43.4%) were the most common, followed by antepartum (32.5%) and intrapartum (24.5%). Risk factors for stillbirths and early neonatal death were low maternal education (aOR 1.747, 95%CI 1.098–2.780), previous stillbirth (aOR 9.447, 95%CI 6.245–14.289), previous preterm birth (aOR 3.620, 95%CI 2.363–5.546), and previous child with congenital abnormality (aOR 2.190, 95% 1.228–3.905), and antepartum hemorrhage during pregnancy (aOR 3.273, 95% 1.523–7.031).ConclusionAntepartum hemorrhaging is the only risk factor in our study amenable for direct intervention. Efforts should be maximized to improve patient education and antenatal and obstetric services. Moreover, the most significant cause of mortality was asphyxia-related causes. It is imperative that obstetric capacity in rehabilitation services are strengthened and for further studies to investigate the high burden of asphyxia at these tertiary hospitals to better tailor interventions.

Relationship of Amniotic Fluid Index (AFI) Between Maternal and Perinatal in Patients

Background: Alcohol amniotic, a protecting fluid that surround the embryo. It protects from concussion, pressure, desiccation, reminiscent of the aquatic origin of life. Adequate amount of amniotic fluid is essential requirement for the normal development and it acts like a cushion against trauma, agitation and accidental impulsions. It has also bacteriostatic properties and prevents the infection of many bacterial infections.&#x0D; Aim: To assess the maternal and fetal outcome in cases with normal and abnormal Amniotic Fluid Index levels.&#x0D; Results: The mode of delivery was spontaneous vaginal delivery followed by Assisted VD, Elective CS, Emergency CS respectively. It was affected by amount of liquor since, low AFI group 35 (75%) patients ended up in cesarean section for fetal distress. While in control group 63(18.3%) patients had caesarean section.&#x0D; Conclusion: Early neonatal death was seen in 0.2%, 4.5% and 70.5% newborns were born to pregnant women with normal AFI, oligohydramnios respectively. 70.5% neonates born to pregnant women with oligohydramnios had NICU admission. All cases were admitted in NICU because of respiratory distress.

A randomized controlled trial of two-doses of vaginal progesterone 400 vs. 200mg for prevention of preterm labor in twin gestations.

To compare between the effectiveness and safety of two different daily doses of vaginal progesterone (400 vs. 200mg) in the prevention of preterm labor in twin pregnancy. This is a prospective single-blinded randomized controlled trial conducted on 100 primi-gravida who had twin pregnancy and attended the antenatal clinic of a University hospital. They were equally and randomly allocated into two arms each containing 50 patients. Arm 1 received 400mg and arm 2 received 200mg vaginal progesterone daily at bed time starting from 14weeks of pregnancy to 36weeks. Transvaginal ultrasound was performed for assessment of the length of cervix at 14 and 22weeks. Both arms of the current study were comparable regarding the cervical length at 14 and 22weeks, mean gestational age at delivery, incidence of pre-term delivery, birth weight of the first twin. Second twin in addition to the average weight of both twins. No statistical significance differences between two arms regarding incidence of early neonatal death. NICU, mechanical ventilation, length of admission in NICU for the first twin. Second twin as well as both twins. Vaginal progesterone treatment with different doses was tolerable, but wasn't effective in the prevention of preterm labor in twin pregnancy.

Effectiveness of the World Health Organization Safe Childbirth Checklist (WHO-SCC) in preventing poor childbirth outcomes: a study protocol for a matched-pair cluster randomized control trial

BackgroundWomen delivering in health facilities in sub-Saharan Africa and their newborns do not always receive proven interventions needed to prevent and/or adequately manage severe complications. The gaps in quality of care are increasingly pointed out as major contributing factor to the high and slow declining perinatal mortality rates. The World Health Organization Safe Childbirth Checklist (WHO-SCC), as a quality improvement strategy, targets low cost and easy to perform interventions and suits well with the context of limited resource settings. In this matched-pair cluster randomized controlled trial, we assess the effectiveness of the WHO-SCC in improving healthcare providers’ adherence to best practices and ultimately improving childbirth outcomes.MethodsThis is a multi-country study. In each country we will carry out a matched-pair cluster randomized controlled trial whereby four pairs of regional hospitals will be randomized on a 1:1 basis to either the intervention or control group. A context specific WHO-SCC will be implemented in the intervention facilities along with trainings of healthcare providers on best childbirth practices and ongoing supportive supervisions. The standard of care will prevail in the control group. The primary outcome is a summary composite metric that combine the following poor childbirth outcomes: stillbirths, maternal deaths, early neonatal deaths, severe postpartum hemorrhage, maternal infections, early neonatal infections, prolonged obstructed labor, severe pre-eclampsia, uterine rupture in the health facility, eclampsia and maternal near miss. The occurrence of these outcomes will be ascertained in a sample of 2530 childbirth events in each country using data extraction. A secondary outcome of interest is the adherence of healthcare providers to evidence best practices. This will be measured through direct observations of a sample of 620 childbirth events in each country.DiscussionOur study has the potential to provide strong evidence on the effectiveness of the WHO-SCC, a low cost and easy to implement intervention that can be easily scaled up if found effective.Trial registrationThe trial was registered in the Pan-African Clinical Trials Registry on 21st January 2020 under the following number: PACTR202001484669907. https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=9662

Risk factors for perinatal loss - reality or fiction?

Aim: to identify factors predisposing to perinatal losses, assessment of which is available at the first (only) visit of pregnant woman in antenatal clinic.Materials and Methods. A retrospective analysis of the medical records of 964 women who performed delivery in 2009-2019 in 15 obstetric facilities was carried out. The patients were divided into 2 groups: the main group included 457 women with perinatal losses (stillbirth - 328 children, and 129 children with early neonatal death); the control group consisted of 507 women, whose children survived 7 days during postnatal period. We analyzed parameters routinely determined by an obstetrician-gynecologist at the first visit of woman during within ongoing pregnancy (regardless of gestation age), namely, social status, anamnesis, data of initial examination.Results. The following significant differences were revealed in pregnant women from the main group: a younger age of pregnancy; no registered marriage and permanent job as well as primary and secondary education; smoking, alcohol and drug use; concurrent diabetes mellitus, hypertensive disorders, blood contact infections, obesity; older menarche age and younger sexual debut age; medical history contains infectious genital pathology, more often pregnancies and childbirths, two or more abortions before repeated childbirth, premature births.Conclusion. Thus, the anamnestic indicators noted above can be used to create prognostic statistical systems and models to determine high risk of perinatal losses of any nature.

Umbilical Cord Prolapse and Perinatal Outcomes in a Tertiary Hospital in Yenagoa, South-South Nigeria: A 5-Year Review

Background: Umbilical cord prolapse is an obstetric emergency when the foetus is still alive, and it is associated with high foetal morbidity and mortality. If umbilical cord prolapse occurs outside the hospital, mortality rate can be as high as 44% – 70%, and as low as 3% when it occurs in the hospital.&#x0D; Objective: To determine the incidence of umbilical cord prolapse and the perinatal outcomes associated with it at the Federal Medical Centre, Yenagoa, Bayelsa State, Nigeria over 5 years.&#x0D; Materials and Methods: This retrospective survey was carried out between 1st January, 2016 and 31st December, 2020. Data were retrieved, entered into a pre-designed proforma, and analysed using IBM SPSS version 25.0. Results were presented in frequencies and percentages for categorical variables and mean and standard deviation for continuous variables.&#x0D; Results: Forty-one women had umbilical cord prolapse out of 4,571 deliveries, giving a case incidence rate of 8.9 per 1,000 deliveries. About three-quarters (75.6%) of the women were multiparous. A fifth (21.9%) of the foetuses died in-utero, while 27 (65.9%) babies survived. Five (15.6%) babies had severe birth asphyxia, and died (early neonatal death) in the special care baby unit. Decision-to-delivery interval was ≤ 30 minutes in only 12.5% of patients.&#x0D; Conclusion: Umbilical cord prolapse is associated with significant perinatal morbidity and mortality. Prompt diagnosis and intervention are very key in preventing adverse perinatal outcomes.

Association of maternal obesity with fetal and neonatal death: Evidence from South and South-East Asian countries.

Obesity prevalence is increasing in many countries in the world, including Asia. Maternal obesity is highly associated with fetal and neonatal deaths. This study investigated whether maternal obesity is a risk factor of fetal death (measured in terms of miscarriage and stillbirth) and neonatal mortality in South and South-East Asian countries. This cross-sectional study pooled the most recent Demographic and Health Surveys (DHS) from eight South and South-East Asian countries (2014-2018). Multivariate logistic regression was deployed to check the relationships between maternal obesity with fetal and neonatal deaths. Finally, multilevel logistic regression model was employed since the DHS data has a hierarchical structure. The pooled logistic regression model illustrated that maternal obesity is associated with higher odds of miscarriage (adjusted odds ratio [aOR]: 1.26, 95% CI: 1.20-1.33) and stillbirths (aOR: 1.46, 95% CI: 1.27-1.67) after adjustment of confounders. Children of obese mothers were at 1.18 (aOR: 1.18, 95% CI: 1.08-1.28) times greater risk of dying during the early neonatal period than mothers with a healthy weight. However, whether maternal obesity is statistically a significant risk factor for the offspring's late neonatal deaths was not confirmed. The significant association between maternal obesity with miscarriage, stillbirth and early neonatal mortality was further confirmed by multilevel logistic regression results. Maternal obesity in South and South-East Asian countries is associated with a greater risk of fetal and early neonatal deaths. This finding has substantial public health implications. Strategies to prevent and reduce obesity should be developed before planning pregnancy to reduce the fetal and neonatal death burden. Obese women need to deliver at the institutional facility centre that can offer obstetrics and early neonatal care.

Perinatal outcomes among births to women with infection during pregnancy

ObjectiveThis study is part of the Global Maternal Sepsis Study (GLOSS). It aimed to estimate neonatal near-miss (NNM) and perinatal death frequency and maternal risk factors among births to women...

Burns in pregnancy: Five-year experience in a tertiary hospital in southeastern Nigeria.

Burns in pregnancy is often associated with high maternal and fetal morbidity and mortality especially when the total burn surface area (TBSA) involved is high. This study aims to review management outcome of cases of burns in pregnancy at Alex Ekwueme Federal University Teaching Hospital Abakaliki (AE-FUTHA). A five year retrospective study of all pregnant women that presented at AE-FUTHA with burn injury between April 2014 and March 2019. Information was collected from the medical records using a proforma and analyzed with IBM SPSS Statistics version 20.0 (IBM Corp., Armonk, NY, USA) using descriptive statistics. A total of 222 cases of burns were managed but only 8 were pregnant, giving an incidence of 3.6%. The commonest causes were flame (62.5%), scald (25%) and friction (12.5%) occurring mostly during the harmattan season. The median age of participants was 25-34 years. The burns affected 12.5% of the patients in the first trimester and 62.5% and 25% in the 2nd and 3rd trimesters respectively. Most patients (62.5%) had superficial burns while 25% had other associated injuries in addition to burns. About 87.5% had term spontaneous vaginal delivery. There was no maternal death but, there was an early neonatal death. The good outcome observed in this study with a 100% survival, could be explained by inter-disciplinary management approach given, even as most cases were minor degrees of burns. Early involvement of obstetricians in all burns affecting pregnant women is advised especially in burn centres where obstetricians are hardly in the employ.

Molecular autopsy by proxy in preconception counseling.

Monogenic diseases that result in early pregnancy loss or neonatal death are genetically and phenotypically highly variable. This often poses significant challenges in arriving at a molecular diagnosis for reproductive planning. Molecular autopsy by proxy (MABP) refers to the genetic testing of relatives of deceased individuals to deduce the cause of death. Here, we specifically tested couples who lost one or more children/pregnancies with no available DNA. We developed our testing strategy using whole exome sequencing data from 83 consanguineous Saudi couples. We detected the shared carrier state of 50 pathogenic variants/likely pathogenic variants in 43 families and of 28 variants of uncertain significance in 24 families. Negative results were seen in 16 couples after variant reclassification. In 10 families, the risk of more than one genetic disease was documented. Secondary findings were seen in 10 families: either genetic variants with potential clinical consequences for the tested individual or a female carrier for X‐linked conditions. This couple‐based approach has enabled molecularly informed genetic counseling for 52% (43/83 families). Given the predominance of autosomal recessive causes of pregnancy and child death in consanguineous populations, MABP can be a helpful approach to consanguineous couples who seek counseling but lack molecular data on their deceased offspring.

Linking a European cohort of children born with congenital anomalies to vital statistics and mortality records: A EUROlinkCAT study.

EUROCAT is a European network of population-based congenital anomaly (CA) registries. Twenty-one registries agreed to participate in the EUROlinkCAT study to determine if reliable information on the survival of children born with a major CA between 1995 and 2014 can be obtained through linkage to national vital statistics or mortality records. Live birth children with a CA could be linked using personal identifiers to either their national vital statistics (including birth records, death records, hospital records) or to mortality records only, depending on the data available within each region. In total, 18 of 21 registries with data on 192,862 children born with congenital anomalies participated in the study. One registry was unable to get ethical approval to participate and linkage was not possible for two registries due to local reasons. Eleven registries linked to vital statistics and seven registries linked to mortality records only; one of the latter only had identification numbers for 78% of cases, hence it was excluded from further analysis. For registries linking to vital statistics: six linked over 95% of their cases for all years and five were unable to link at least 85% of all live born CA children in the earlier years of the study. No estimate of linkage success could be calculated for registries linking to mortality records. Irrespective of linkage method, deaths that occurred during the first week of life were over three times less likely to be linked compared to deaths occurring after the first week of life. Linkage to vital statistics can provide accurate estimates of survival of children with CAs in some European countries. Bias arises when linkage is not successful, as early neonatal deaths were less likely to be linked. Linkage to mortality records only cannot be recommended, as linkage quality, and hence bias, cannot be assessed.

He Tamariki Kokoti Tau: Tackling preterm incidence and outcomes of preterm births by ethnicity in Aotearoa New Zealand 2010-2014.

To explore preterm birth among Māori indigenous peoples through Kaupapa Māori research of preterm birth in Aotearoa New Zealand. Linked maternity, mortality, and hospital data were analyzed for women and their infants born between January 1, 2010 and December 31, 2014. Relative risks (RR) were calculated for each ethnic group for preterm birth, small for gestational age (SGA), and mortality. Adjusted rates showed that compared with Māori women, European women were at significantly less risk of having extremely and very preterm infants (RR 0.86, 95% confidence interval [CI] 0.76-0.95). Preterm infants of European women had a significantly lower adjusted RR of early neonatal death (RR 0.65, 95% CI 0.45-0.93) or post-neonatal death (RR 0.41, 95% CI 0.26-0.64). In addition to ethnicity, preterm rates were influenced by maternal age, body mass index, smoking status, and SGA status. This study demonstrates that the Aotearoa New Zealand maternity system privileges whiteness, suggesting that clinical pathways for evidence-based medical care are not delivered systemically and equitably for all. Health pathways that focus on equity as a fundamental right will enhance health outcomes for Māori women and their infants.