Intrapartum Fetal Death Research Articles

Embryotomy for head last retention: A case report from Thiès, Senegal

Introduction: Hydrocephalus is a pathology of heterogeneous nature and complex pathogenesis. It corresponds to an active distension of the ventricular system. Faced with hydrocephalus with retained head in a dead child, embryotomy by craniotomy is indicated. Case Report: We report a case of intrapartum fetal death with head-last retention due to hydrocephalus treated with craniotomy performed at the regional hospital of Thiès (CHRT). This was a 21-year-old primigravida patient seen for premature delivery in a pregnancy of 33 weeks 5 days. The ultrasound concluded that the pregnancy had stopped at 33 weeks 5 days with major hydrocephalus. A craniotomy followed by gradual evacuation of the cerebrospinal fluid allowed easy delivery of a fresh stillborn weighing 1950 grams. The afterbirth was simple. Conclusion: Embryotomy by craniotomy constitutes a good option to complete delivery by natural means in the face of head retention due to hydrocephalus with intrapartum death. It is therefore necessary to master this simple and less morbid technique than a cesarean section in such a situation.

Prospective Community-based Study of Still Births in Remote Villages with Low Resources

Background: Stillbirth (SB), either because of intrauterine or intrapartum fetal death, is amongst the most devastating pregnancy complications, hardest to predict, real challenge for health systems. India probably accounts for the highest SB numbers in the world. Objectives: A community-based prospective study was carried out to know the burden, and causes of SBs in rural women of remote regions. Material methods: After approval of the ethics committee of the Institute in Maharashtra for broader research, which was service-oriented, the present study was conducted in 100 villages around the village with health facilities. These villages were included keeping in mind future services. After obtaining the consent of women, information was prospectively recorded on their predesigned tool (which was for broader work), by asking women and seeing their records of antenatal and intranatal care on a regular basis. The study subjects were selected after obtaining information from nurse midwives, Accredited Social Health Activists (ASHAs), and Aaganwadi workers. As the plan was to serve, there was excellent cooperation. The tool was made for broader work. Villages were visited 5 days a week. Study was community-based in villages in remote, hilly regions with various local issues so any information the women told and was in the record was used. Results: A total of 3905 births occurred over two years, 3635 (93%) term, and 270 (7%) preterm. Amongst 3635 term births, 3474 (95.6%) were live births, 161 (4.4%) SBs, amongst 270 preterm births, 239 (88.5%) were live births, 31 (11.5%) SBs. Of 192 SBs, 48 (7.2%) SBs were amongst 2690 women with anaemia, (16 (2.4%) SBs amongst women with very severe anaemia, 12 (1.8%) SBs were amongst 667 women with severe anaemia, 12 (1.8%) SBs were amongst 664 women with moderate anaemia, 8(1.2%) SBs were amongst 680 women with mild anaemia). Overall of 192 (4.9%) SBs, 31 (18.1%) SBs were among 517 women with hypertensive disorders of pregnancy (HDsP) 8 (4.4%) SBs amongst 280 women with moderate HDsP, 12 (6.9%) SBs amongst 175 women with severe HDsP, 11 (6.8%) SBs in 62 women with eclampsia. Overall of 192 SBs, 6 (3.1%) babies had weight < 1 kg, 8 (4.1%) of ≥ 1 to < 1.5 kg, 50 (26.0%) ≥ 1.5 to < 2 kg, 64 (33.3%) ≥ 2 to < 2.5 kg, 64 (33.3%) 2.5 kg and more, obviously fewer babies more deaths in birth weight less than 1. 5 kg, more so less than 1 kg. Conclusion: Overall SBs were in women with disorders but 4.5% SBs did occur in women with no disorder. SBs were significantly higher amongst babies weighing less than 1 kg, beyond this weight, numbers were similar.

СОВРЕМЕННЫЙ ПОДХОД К ОЦЕНКЕ ПЕРИНАТАЛЬНОГО РИСКА, ОСНОВАННЫЙ НА ИСПОЛЬЗОВАНИИ ПРОГНОСТИЧЕСКИХ КРИТЕРИЕВ АНТЕНАТАЛЬНЫХ, ИНТРАНАТАЛЬНЫХ И РАННИХ НЕОНАТАЛЬНЫХ ПОТЕРЬ

The problem of perinatal losses is still actual in obstetrics today. At the same time there are cases of non-estimation or extra-estimation of perinatal risk in obstetrical practice. The usage of famous prognostic systems gives the opportunity to select pregnant women into groups of high risk and provide the necessary organizational and tactic measures. But to define the character of possible complications, to establish the degree of their severity and time of appearance is really impossible. Objective of the study: to develop a new approach to estimation of perinatal risk based on the determination of prognostic criteria for antepartum and intrapartum fetal death, early neonatal death of a newborn in order to increase the efficacy of predicting of unfavourable perinatal outcomes. Materials and research methods. The retrospective case-control study in patients with antepartum (n=134) and intrapartum (n=41) fetal death, early neonatal death of the newborn (n=61) and favourable perinatal outcome (n=50) was conducted. There was used the Bayes algorhythm with Wald's consecutive analysis in the modification of Genkin-Gubler to determine prognostic criteria. The comparative estimation of the efficacy of the proposed prognostic method and traditional method of determining perinatal risk was performed retrospectively in patients with perinatal losses (n=102) and favourable perinatal outcome (n=100). ROC analysis was performed. Results. There were identified 42 risk factors divided into three groups: universal for all types of perinatal losses, common for two of them and specific for each of them (antepartum and intrapartum fetal death, early neonatal death of a newborn). There was determined the prognostic influence of factors in their presence and absence. It was found that universal and common risk factors had different prognostic influence for each type of perinatal losses. There was presented the method for differential predicting of perinatal losses. The sensitivity of the new and traditional prognostic methods was 95.1% and 69.6%, specificity was 80% and 53%, and the accuracy of predicting of unfavourable outcome was 87.6% and 61.4% respectively. Conclusion. The investigation permitted to propose the new approach to estimation of perinatal risk, based on differential predicting of perinatal losses being is more effective than traditional method in predicting adverse perinatal outcomes.

ПОЛ ПЛОДА В ОЦЕНКЕ РИСКА АНТЕНАТАЛЬНЫХ, ИНТРАНАТАЛЬНЫХ И РАННИХ НЕОНАТАЛЬНЫХ ПОТЕРЬ

Unfavorable demographic trends, combined with unstable dynamics of perinatal mortality rates, require improvement of the perinatal forecasting system. The search for new perinatal risk factors is also becoming relevant. The appearance of publications on the influence of sexual dimorphism on the course of pregnancy and childbirth indicates the need to study the possibility of using this factor in predicting perinatal losses. Objective of the study: to study the role of fetal sex as a risk factor for antepartum and intrapartum fetal death, early neonatal death of a newborn. Materials and research methods. A retrospective study was conducted with the participation of patients with antepartum (n=70) and intrapartum (n=40) fetal death, early neonatal death of a newborn (n=50) and a favorable perinatal outcome (n=50) as a control. We studied the structure of patients by fetal sex, conducted its comparative analysis in these groups, determined the prognostic value of fetal sex in antepartum, intrapartum fetal death and early neonatal death of a newborn. We used the program "Statistica 10.0" for statistical processing of the obtained data and the Bayes model of prediction with analysis by A. Wald, method of E.V. Gubler and the criterion of S. Kullback. Results. The male sex of the fetus prevailed over the female in all groups of perinatal risk. In the group with a favorable perinatal outcome, on the contrary, female fetuses were more common. We found a statistically significant difference in fetal sex between the antepartum risk and control groups: the male sex of the fetus occurred at antenatal losses 1.5 times more often than at favorable perinatal outcomes (p=0.028). We have calculated prognostic coefficients and indicators of the informativeness of fetal sex in antepartum, intrapartum and early neonatal losses. We have determined the prognostic value of fetal sex and established the nature of its effect on perinatal prognosis for each of the risk groups. Conclusion. The conducted study allows us to consider the sex of the fetus as a factor of differentiated risk of antepartum, intrapartum and early neonatal losses. The obtained results clearly demonstrate the prognostic role of fetal sex and indicate the need to include this factor in the perinatal risk assessment system at each stage of the perinatal period.

Induction of labor in term pregnancies with isolated polyhydramnios: Is it beneficial or harmful?

To compare rates of adverse pregnancy outcomes in term pregnancies complicated by polyhydramnios between women who had induction of labor (IOB) versus women who had expectant management. This multicenter retrospective study included term pregnancies complicated by isolated polyhydramnios. Patients who underwent IOB were compared with those who had expectant management. The primary outcome was defined as a composite adverse maternal outcome, and secondary outcomes were various maternal and neonatal adverse outcomes. Univariate analyses were followed by multivariate logistic regression. A total of 865 pregnancies with term isolated polyhydramnios were included: 169 patients underwent IOB (19.5%), while 696 had expectant management and developed spontaneous onset of labor (80.5%). Women who underwent IOB had significantly higher rates of composite adverse maternal outcome (23.1% vs 9.8%, P < 0.01), prolonged hospital stay, perineal tear grade 3/4, intrapartum cesarean, postpartum hemorrhage, blood products transfusion, and neonatal asphyxia compared with expectant management. While the perinatal fetal death rate was similar between the groups (0.6% vs 0.6%, P = 0.98), the timing of the loss was different. Four women in the expectant management group had a stillbirth, while in the induction group one case of intrapartum fetal death occurred due to uterine rupture. Multivariate analyses revealed that IOB was associated with a higher rate of composite adverse maternal outcome (adjusted odds ratio, 2.22 [95% CI, 1.28-3.83]; P < 0.01). IOB in women with term isolated polyhydramnios is associated with higher rates of adverse maternal outcomes in comparison to expectant management. Further research is needed to determine the optimal approach for the management of isolated polyhydramnios at term.

Risk of stillbirth after a previous caesarean delivery: A Swedish nationwide cohort study.

To investigate the risk of stillbirth in relation to (1) a previous caesarean delivery (CD) compared with those following a vaginal birth (VB); and (2) vaginal birth after caesarean (VBAC) compared with a repeat CD. Population-based cohort study. The Swedish Medical Birth registry. Women with their first and second singletons between 1982 and 2012. Multivariable logistic regression models were performed to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI) of the association between CD in the first pregnancy and stillbirth in the second pregnancy and the association between VBAC and stillbirth. Sub-group analyses were performed by types of CD and timing of stillbirth (antepartum and intrapartum). Stillbirth (antepartum and intrapartum fetal death). Of the 1 771 700 singleton births from 885 850 women, 117 114 (13.2%) women had a CD in the first pregnancy, and 51 755 had VBAC in the second pregnancy. We found a 37% increased odds of stillbirth (aOR 1.37; 95% CI 1.23-1.52) in women with a previous CD compared with VB. The odds of intrapartum stillbirth were higher in the previous pre-labour CD group (aOR 2.72; 95% CI 1.51-4.91) and in the previous in-labour CD group (aOR 1.35; 95% CI 0.76-2.40), although not statistically significant in the latter case. No increased odds were found for intrapartum stillbirth in women who had VBAC (aOR 0.99; 95% CI 0.48-2.06) compared with women who had a repeat CD. This study confirms that a CD is associated with an increased risk of subsequent stillbirth, with a greater risk among pre-labour CD. This association is not solely mediated by increases in intrapartum asphyxia, uterine rupture or attempted VBAC. Further research is needed to understand this association, but these findings might help healthcare providers to reach optimal decisions regarding mode of birth, particularly when CD is unnecessary.

Incidence, causes, and risk factors of stillbirth in an Amazonian context: Saint Laurent du Maroni maternity ward 2016–2021

We aimed to describe the epidemiology of intrauterine fetal deaths in multiethnic western French Guiana and to assess its main causes and risk factors. A retrospective descriptive study was conducted based on data from January 2016 to December 2021. All information on stillbirth with a gestational age ≥20 weeks in the Western French Guiana Hospital Center was extracted. Terminations of pregnancy were excluded. We focused on medical history, clinical investigation, biological findings, placental histology, and autopsy examination to elucidate the cause of death. We used the Initial Cause of Fetal Death (INCODE) classification system for assessment. Univariable and multivariable logistic regression analyses were performed. Overall, 331 fetuses in 318 stillbirth deliveries were reviewed and compared to live births that occurred during the same period. The rate of fetal death varied between 1.3 % and 2.1 %, with an average of 1.8 % over the 6-year period. Poor antenatal care (104/318, 32.7 %), obesity ≥30kg/m2 (88/318, 31.7 %), and preeclampsia (59/318, 18.5 %) were the main risk factors associated with fetal death in this group. Four hypertensive crises were reported. According to the INCODE classification, the main causes of fetal death were obstetric complications (112/331, 33.8 %), particularly intrapartum fetal death with labor-associated asphyxia under 26 weeks (64/112, 57.1 %), and placental abruption (29/112, 25.9 %). Maternal-fetal infections were common, particularly mosquito-borne diseases (e.g., Zika virus, dengue, and malaria), re-emerging infectious agents such as syphilis, and severe maternal infections (8/331, 2.4 %). 19.3 % of fetal deaths (64/331) remained unexplained. Change in lifestyle as well as social deprivation and isolation adversely affect pregnancy in western French Guiana, in the context of a poor health care system that is similar to what is found in the Amazonian basin. Particular attention must be paid to emerging infectious agents in pregnant women and travelers returning from the Amazon region.

Factors associated with intrapartum stillbirth in a tertiary teaching hospital in Burkina Faso.

Intrapartum stillbirth is an indicator of health and community development. To identify the risk factors associated with intrapartum stillbirth in a tertiary teaching hospital in Burkina Faso. A case-control study conducted from January 1 to August 30, 2019. Cases were defined as patients admitted to Yalgado Ouedraogo teaching hospital (YOTH) with a live fetus of at least 28 weeks' gestation and who gave birth to an intrapartum stillborn, a fetus delivered without any signs of life in the first minute postpartum. Controls were defined as patients who delivered a live newborn. Study controls were gradually recruited and matched to cases. For each case, two controls were recruited and matched according to criteria such as delivery route and day of delivery. Data were cleaned in Epidata and exported to Stata for analysis. Variables with a p < 0.05 significance level in the multivariable regression were retained. Odds ratio (OR) and 95% confidence intervals are reported. Eighty-three intrapartum stillbirths were documented among a total of 4,122 deliveries, a stillbirth rate of 20.1 per 1,000 births. There was a statistically significant association between intrapartum stillbirth and prior caesarean section (p = 0.045), multiparity (p = 0.03), the receipt of antenatal care (ANC) by a nurse (p = 0.005) and the disuse of the partogram (p = 0.004). We did not find a significant association between the number of ANC consultations performed (p = 0.3), whether membranes were ruptured at admission (p = 0.6), the duration of labor (p = 0.6) and intrapartum fetal death. Multivariate analysis showed that patient referral to another heath facility (OR: 3.33; 95% IC: 1.56, 7.10), no obstetric ultrasound performed (OR: 3.16; 95% IC: 2.11, 4.73), birth weight less than 2,500 g (OR: 7.49; 95% IC: 6.40, 8.76) were significantly associated with intrapartum stillbirth. Specific interventions must be taken to identify these risk factors of intrapartum stillbirth in order to ensure better and appropriate management.

Critical analysis of risk factors for intrapartum death

Intrapartum fetal death is devastating for both parents and medical caregivers. Management in subsequent pregnancies is often based on risk factors. The purpose of this study was to evaluate risk factors for intrapartum fetal death.

Critical analysis of risk factors for intrapartum fetal death.

Intrapartum fetal death is devastating for both parents and medical caregivers. The purpose of this study was to evaluate the risk factors for intrapartum fetal death, which often influence management in subsequent pregnancies. This population-based cohort study included all singleton deliveries between the years 1991-2016 at Soroka University Medical Center. Trends over the years, risk factors for intrapartum fetal death and the effect of day of the week were examined. A generalized estimation equation (GEE) model was used to control for confounders. During the study period 344,536 deliveries were recorded, of which 251 (0.1%) suffered intrapartum fetal death. Rates did not change significantly over the years (p = 0.130, using the chi-square test for trends). Preterm delivery, placental abruption, uterine rupture, shoulder dystocia, congenital malformations, severe preeclampsia and fetal malpresentation were significantly more common in pregnancies complicated by intrapartum death. Using a GEE model; shoulder dystocia (aOR 23.8, 95% CI 9.9-57.3, p < 0.005), uterine rupture (aOR 19.0, 95% CI 7.0-51.4, p < 0.05), preterm delivery (aOR 11.9, 95% CI 8.6-16.5, p < 0.001), placental abruption (aOR 6.2, 95% CI 4.1-9.4, p < 0.001), fetal malpresentation (aOR 3.6, 95% CI 2.6-4.9, p < 0.005) and congenital malformations (aOR 2.6, 95% CI 1.9-3.5, p < 0.05) were all independent risk factors for intrapartum fetal death. Weekend deliveries were not at increased risk of intrapartum fetal death. Several risk factors were identified for intrapartum fetal death, with shoulder dystocia demonstrating the highest risk. Unfortunately most factors are neither preventable nor predictable and interventions to decrease the rate of intrapartum fetal death remain elusive.

Fetal death: analysis of angiogenic factors during pregnancy

Background: Fetal mortality is still insufficiently studied. Objectives: Analyze angiogenic factors (PlGF) in maternal-fetal interface and associate then with fetal mortality. Methods: This is part of a case control study from 15 public branch hospitals of Sao Paulo City were we selected fetal death and live births. Inclusion criteria: Single pregnancy; fetus and live births: &amp;#x2265; than 22 and &amp;#x2264; than 45 weeks of gestation and/or birth weight &amp;#x2265; 500g. Exclusion criteria: Absence of judicial termination of pregnancy and of maternal death on birth room Results: We analized 23 patients case and 23 controls. Birth weight averaged was 2290 grams for case group and 3177 grams for control (p &amp;#x3c; 0.001) (Mann-Whitney). Gestational age ranged from 27 to 39 weeks in case group and from 32 to 42 weeks in control (p &amp;#x3c; 0.001) (Qui Square) Maternal PlGF of case group had a mean of 433.9 and of the control had 132.6 (p = 0.005). Umbilical cord PlGF of case group had a mean of 358.2 and the control had 10.41 pg/mL (p &amp;#x3c; 0.001). Median PlGF of umbilical cord of pregnant women who had preterm birth was 358.7 and of those who had delivered at term was 15.1 (p &amp;#x3c; 0.001) (Mann-Whitney). Comparing PlGF of the control group and the fetal death group (intrapartum or antepartum) we found difference between live births and mothers who had intrapartum fetal death. By Dunn&amp;#x27;s post hoc test, the difference for maternal PLGF is between live birth vs intrapartum (p=0.012), similarly for cord PLGF (p&amp;#x3c;0.001) Conclusions: We found differences between the PlGF of the blood of the mother and the umbilical cord of the case and control. We intend to analyze the sFlt and relate them with the occurrence of fetal death and other obstetric parameters. Keywords: Fetal mortality, angiogenic factors and pregnancy

ВОЗРАСТНЫЕ АСПЕКТЫ АНТЕНАТАЛЬНЫХ, ИНТРАНАТАЛЬНЫХ И РАННИХ НЕОНАТАЛЬНЫХ ПОТЕРЬ

Abstract. Unfavorable demographic trends, combined with the aging of the population, make it possible to consider the reduction and prevention of perinatal losses as a potential demographic reserve. The reduction in the number of women of active reproductive age, the increase in the birth rate among women over 35 years of age and the lack of a unified scientific opinion regarding the age of mothers unfavorable for the perinatal period indicate the need for research and consideration of age-related aspects in the prediction and prevention of perinatal losses. Objective of the study: to study the role of women's age as a risk factor for antenatal and intrapartum fetal death, early neonatal death of a newborn. Materials and research methods. A retrospective study was conducted with the participation of patients with antenatal (n=134) and intrapartum (n=41) fetal death, early neonatal death of a newborn (n=61) and a favorable perinatal outcome (n=50) as a control. We studied the age of women, conducted a comparative analysis of the age structure of these groups, determined the prognostic weight of significant age intervals in antenatal, intrapartum fetal death and early neonatal death of a newborn. We used the program "Statistica 10.0" for statistical processing of the obtained data and the Bayes model of prediction with analysis by A. Wald, method of E.V. Gubler and the criterion of S. Kullback. Results. We found that there was a statistically significant difference in the age of patients between the groups of antenatal risk and control (p=0.01), as well as antenatal and early neonatal risk (p=0.003). A comparative analysis of the age structure of the groups showed that patients aged 15-19 years were significantly more likely, in comparison with the control, to occur in the early neonatal risk group (p=0.003), and women aged 30 and over ‒ in the antenatal (p=0.002) and intranatal (p= 0.01) risk groups. We have calculated prognostic coefficients and indicators of informativeness of the most significant age intervals in the blood serum of pregnant women with antenatal fetal death, intrapartum fetal death and early neonatal death of a newborn. We have determined age intervals that worsen and improve the perinatal prognosis. Conclusion. The conducted study allows us to consider certain age categories of women as factors of differentiated risk of antenatal, intrapartum and early neonatal losses. The obtained results clearly demonstrate the prognostic role of women's age and indicate the need to include this factor in the systems for assessing the condition of the fetus and newborn at each stage of the perinatal period.

Induction of labor in twin pregnancies – A retrospective cohort study

ObjectiveTo investigate outcomes in spontaneous and induced twin deliveries. Secondary aims were to study impact of delivery interval and breech presentation of the first twin. MethodsThis retrospective cohort study comprised 354 twin deliveries at a tertiary Norwegian hospital. Spontaneous labor onset and induction of labor were compared in women with planned vaginal delivery and gestational age ≥ 34 weeks. The main outcome was intrapartum cesarean section. Secondary outcomes were umbilical arterial pH and five-minute Apgar scores. ResultsAmong the induced labors, 63/229 (27.5%) women underwent intrapartum cesarean section, compared to 45/125 (36%) in spontaneous labors (P = 0.10). Odds ratio for intrapartum cesarean section in induced labors was 0.65 (95% CI 0.40–1.04) after adjusting for maternal age and parity.Median umbilical arterial pH was significantly lower in the second twins in both spontaneous and induced labors, 7.28 (6.94–7.43) vs. 7.32 (7.16–7.42), and 7.27 (6.90–7.48) vs. 7.29 (7.08–7.45), respectively. pH < 7.00 rarely occurred. Second twins born after a delivery interval > 30 min had a significantly higher frequency of pH < 7.10 than those with a shorter interval, P < 0.01. No significant difference was found in frequency of pH < 7.10 between breech-presenting and cephalic-presenting first twins (P = 0.65). One unexpected intrapartum fetal death occurred after labor induction. ConclusionOur results support spontaneous onset and induction of labor as safe. Intrapartum cesarean section rates did not differ significantly between spontaneous and induced labors. Delivery interval > 30 min was associated with a lower pH in the second twin.

Sociodemographic, living environment and maternal health associations with stillbirth in a tertiary healthcare setting in Kano, Northern Nigeria

Background&#x0D; Stillbirths are reported as one of the most neglected tragedies in global health, with around 2m stillbirths occurring annually and the majority occurring in low- and middle income countries (LMICs). Many antenatal stillbirths are due to preventable conditions such as maternal infections and non-communicable diseases. Almost half of all stillbirths occur during the intrapartum period, with many linked to obstetric complications. Known risk factors for stillbirths overall include young or advancing maternal age, fetal infection, maternal hypertensive conditions, perinatal asphyxia, history of previous stillbirth, obstetric complications, intrauterine growth restriction and abruptio placenta/placenta praevia. Common non-clinical risk factors include lack of education, socioeconomic deprivation and substandard antenatal care.&#x0D; Methods&#x0D; A single site prospective observational study conducted over three-months was conducted in a tertiary referral hospital in Kano, Nigeria. Eligible participants were mothers presenting at the site in labour and their babies.&#x0D; Demographic and clinical data were collected by paper-based questionnaires. Data were collected on living environment, health and medical history, pregnancy history and pregnancy/birth factors. Each mother answered pre-delivery questions, with potential follow-on questions dependent on birth outcome. Further data points were collected from clinical observations. Photographs were taken of stillborn babies to support data collected and to aid the UK team on classifying degrees of maceration in an attempt to identify antenatal and intrapartum fetal death.&#x0D; Findings&#x0D; Higher odds of stillbirth were associated with low levels of education, a further distance to travel from home to the hospital, living in a shack, maternal hypertension and having had a previous stillbirth after adjusting for all sociodemographic and health features. Higher odds of intrapartum stillbirth included; shoulder presentation, compound presentation and breech presentation compared to cephalic presentation. Other birth related factors associated with higher odds of stillbirth included reported birthing complications, duration of labour being &gt;=18 hours), antepartum haemorrhage, prolonged/obstructed labour, vaginal breech delivery, emergency Caesarean-section delivery, and signs of trauma to the neonate.&#x0D; ConclusionsIdentified risk factors associated with stillbirths are relatively amenable to intervention and a lot of work has been conducted globally, so the development of intervention with sufficient funding should be a relatively rapid process.&#x0D; For collaborations please contact: Email: miltonrl1@cardiff.ac.uk

Application of the international classification of diseases-perinatal mortality (ICD-PM) system to stillbirths: A single center experience in a middle income country

ObjectiveThe present study is intended to investigate the causes of stillbirth and its relationship with maternal conditions using the International Classification of Diseases-Perinatal Mortality (ICD-PM) system. Material and methodsAll early and late fetal deaths between 2015 and 2020 were analyzed. Time of death, fetal causes, and the maternal conditions involved were identified using the ICD-PM classification system. ResultsDuring the study period, out of 74,102 births a total of 475 stillbirths were recorded (6.4 per 1000 births), of which 83.6% of the cases were antepartum and 11.8% were intrapartum fetal deaths, and the time of death could not be determined in 4.6% of the cases. Fetal developmental disorder was the most common cause of antepartum fetal death (24.2%). Intrapartum deaths were mostly due to extremely low birth weight (44.6%). The most common maternal conditions involved were complications of placenta, cord, and membranes (19.8%). ConclusionThe applicability of the ICD-PM classification system for stillbirths is easy. It was observed that fetal deaths mostly occurred in the antepartum period and the cause of death could not be identified in over half of these antepartum fetal deaths. In over half of the stillbirths, there is at least one maternal condition involved. The most common maternal conditions involved are complications of placenta, cord, and membranes. The most common maternal medical problem is hypertensive diseases of pregnancy.

Prognosis of iron deficiency anemia in pregnant women with different somatotypes

BACKGROUND: Anemia during pregnancy, undiagnosed and untreated promptly, is the cause of various obstetric complications: spontaneous miscarriages, premature birth, placental insufficiency, obstetric bleeding, ante- and intrapartum fetal death.&#x0D; AIM: The aim of this study was to evaluate the incidence of iron deficiency anemia in pregnant women with different somatotypes and to develop a prognostic model for the pathology onset.&#x0D; MATERIALS AND METHODS: We examined 390 pregnant women. Somatometry was performed according to the method of R.N. Dorokhov in terms of pregnancy not exceeding 9-10 weeks. Of the examined pregnant women, 110 were of the macrosomatotype, 173 of the meso- and 107 of the microsomatotype. In a clinical blood test, the levels of hemoglobin and red blood cells were determined using well-known methods. Blood iron levels were evaluated by the colorimetric method with ferrozine using a Parma Iron Reagents Kit (Parma Diagnostics Ltd., Russia). Serum hepcidin levels were determined spectrophotometrically using ELISA methods.&#x0D; RESULTS: Iron deficiency anemia was most commonly detected in pregnant women of the macro- and microsomatotype, when compared to those of the mesosomatotype (p 0.05). There was no severe anemia in the study groups. The levels of hematological parameters (serum iron and serum hepcidin) were significantly higher in the group of pregnant women with latent anemia, compared to the study group without signs of anemia (p 0.05). In the second trimester, iron deficiency anemia occurred in the group of patients with latent anemia. Using multiple regression analysis, a formula was obtained for predicting the onset of iron deficiency anemia in pregnant women of different somatotypes.&#x0D; CONCLUSIONS: Hematological parameters (serum iron and serum hepcidin) should be attributed to markers of iron deficiency anemia and timely predict the onset of pathology. The mathematical formula obtained allows predicting with high accuracy the onset of iron deficiency anemia in pregnant women, taking into account the somatotype in the first trimester of pregnancy, and timely preventing the onset of pathology.

Reduced fetal growth velocity precedes antepartum fetal death.

To determine whether decreased fetal growth velocity precedes antepartum fetal death and to evaluate whether fetal growth velocity is a better predictor of antepartum fetal death compared to a single fetal biometric measurement at the last available ultrasound scan prior to diagnosis of demise. This was a retrospective, longitudinal study of 4285 singleton pregnancies in African-American women who underwent at least two fetal ultrasound examinations between 14 and 32 weeks of gestation and delivered a liveborn neonate (controls; n = 4262) or experienced antepartum fetal death (cases; n = 23). Fetal death was defined as death diagnosed at ≥ 20 weeks of gestation and confirmed by ultrasound examination. Exclusion criteria included congenital anomaly, birth at < 20 weeks of gestation, multiple gestation and intrapartum fetal death. The ultrasound examination performed at the time of fetal demise was not included in the analysis. Percentiles for estimated fetal weight (EFW) and individual biometric parameters were determined according to the Hadlock and Perinatology Research Branch/Eunice Kennedy Shriver National Institute of Child Health and Human Development (PRB/NICHD) fetal growth standards. Fetal growth velocity was defined as the slope of the regression line of the measurement percentiles as a function of gestational age based on two or more measurements in each pregnancy. Cases had significantly lower growth velocities of EFW (P < 0.001) and of fetal head circumference, biparietal diameter, abdominal circumference and femur length (all P < 0.05) compared to controls, according to the PRB/NICHD and Hadlock growth standards. Fetuses with EFW growth velocity < 10th percentile of the controls had a 9.4-fold and an 11.2-fold increased risk of antepartum death, based on the Hadlock and customized PRB/NICHD standards, respectively. At a 10% false-positive rate, the sensitivity of EFW growth velocity for predicting antepartum fetal death was 56.5%, compared to 26.1% for a single EFW percentile evaluation at the last available ultrasound examination, according to the customized PRB/NICHD standard. Given that 74% of antepartum fetal death cases were not diagnosed as small-for-gestational age (EFW < 10th percentile) at the last ultrasound examination when the fetuses were alive, alternative approaches are needed to improve detection of fetuses at risk of fetal death. Longitudinal sonographic evaluation to determine growth velocity doubles the sensitivity for prediction of antepartum fetal death compared to a single EFW measurement at the last available ultrasound examination, yet the performance is still suboptimal. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.

Second stage expedite delivery of low birth weight neonates: Emergent cesarean delivery versus vacuum assisted delivery

ObjectiveTo determine maternal and neonatal outcomes among women undergoing second stage emergent cesarean delivery (ECD) versus vacuum-assisted delivery (VAD) of low birthweight neonates. Materials and methodsA retrospective cohort study from two tertiary medical centers. We included women who underwent either ECD or VAD during the second stage of labor, and delivered neonates with a birthweight of <2500 g during 2011–2019. Characteristics and outcomes were compared between the groups. The primary outcome was the rate of a composite adverse neonatal outcome, defined as the presence of ≥1 of the following: Apgar 5 min < 7, respiratory distress syndrome, neonatal intensive care unit admission, mechanical ventilation and intrapartum fetal death. ResultsThe study cohort included 611 patients, of whom 46 had ECD and 565 had VAD. Baseline characteristics did not differ between the groups. The rate of Apgar score < 7 at 1 min was higher among the ECD group]10 (22%) vs. 29 (5%), OR (95% CI) 5.1 (2.3–11.3), p < 0.001[. Other neonatal and maternal outcomes were similar in both groups. ConclusionsNeonatal and maternal outcomes do not differ substantially between ECD and VAD of neonates weighing <2500 g. This information may be useful when contemplating the preferred mode of delivery in this setting.

Современный подход к стратификации перинатального риска

Objective. To develop a new approach to perinatal risk stratification based on the determination of prognostic criteria for antepartum and intrapartum fetal death, and early neonatal death to improve the efficiency of predicting adverse perinatal outcomes. Patients and methods. A retrospective case-control study with the participation of patients with antepartum (n = 134) and intrapartum (n = 41) fetal death, early neonatal death (n = 61), and favorable perinatal outcome (n = 50) was carried out. The Bayes–Wald–Gubler method was used to determine prognostic criteria. Comparative evaluation of the efficacy of the proposed prognostic method and the generally accepted determination of perinatal risk was performed retrospectively in patients with perinatal loss (n = 102) and favorable perinatal outcome (n = 100); ROC analysis was performed. Results. Forty-two risk factors were identified and divided into three groups: universal for all types of perinatal loss, common for two of them, and specific for each of them (antepartum and intrapartum fetal death, early neonatal death). The prognostic value of factors in their presence and absence was determined. It was found that universal and common risk factors for each type of perinatal loss had different prognostic value. The method of differential prediction of perinatal loss was presented. The sensitivity of the new and generally accepted prognostic methods was 95.1 and 69.6%, the specificity was 80 and 53%, and the accuracy of predicting adverse outcomes was 87.6 and 61.4%, respectively. Conclusion. The conducted study allowed to suggest a new approach to perinatal risk stratification based on differential prediction of perinatal loss, which is superior to the traditional risk assessment methods in terms of the effectiveness of predicting adverse perinatal outcomes. Key words: antepartum fetal death, intrapartum fetal death, perinatal outcomes, prediction, early neonatal death

Impact of the COVID-19 Pandemic on Excess Perinatal Mortality and Morbidity in Israel.

The 2020 COVID-19 pandemic has been associated with excess mortality and morbidity in adults and teenagers over 14 years of age, but there is still limited evidence on the direct and indirect impact of the pandemic on pregnancy. We aimed to evaluate the effect of the first wave of the COVID-19 pandemic on obstetrical emergency attendance in a low-risk population and the corresponding perinatal outcomes. This is a single center retrospective cohort study of all singleton births between February 21 and April 30. Prenatal emergency labor ward admission numbers and obstetric outcomes during the peak of the first COVID-19 pandemic of 2020 in Israel were compared with the combined corresponding periods for the years 2017 to 2019. During the 2020 COVID-19 pandemic, the mean number of prenatal emergency labor ward admissions was lower, both by daily count and per woman, in comparison to the combined matching periods in 2017, 2018, and 2019 (48.6 ± 12.2 vs. 57.8 ± 14.4, p < 0.0001 and 1.74 ± 1.1 vs. 1.92 ± 1.2, p < 0.0001, respectively). A significantly (p = 0.0370) higher rate of stillbirth was noted in the study group (0.4%) compared with the control group (0.1%). All study group patients were negative for COVID-19. Gestational age at delivery, rates of premature delivery at <28, 34, and 37 weeks, pregnancy complications, postdate delivery at >40 and 41 weeks, mode of delivery, and numbers of emergency cesarean deliveries were similar in both groups. There was no difference in the intrapartum fetal death rate between the groups. The COVID-19 pandemic stay-at-home policy combined with patient fear of contracting the disease in hospital could explain the associated higher rate of stillbirth. This collateral perinatal damage follows a decreased in prenatal emergency labor ward admissions during the first wave of COVID-19 in Israel. · Less obstetrical ER attendance is observed during the pandemic.. · There is a parallel increase in stillbirth rate.. · Stillbirth cases tested negative for COVID-19.. · Lockdown and pandemic panic are possible causes..