Number Of Fetal Deaths Research Articles

Prenatal exposure to Benzo[a]pyrene affects maternal–fetal outcomes via placental apoptosis

Prenatal exposure to Benzo[a]pyrene (BaP) has been suggested to increase the risk of adverse pregnancy outcomes. However, the role of placental apoptosis on BaP reproductive toxicity is poorly understood. We conducted a maternal animal model of C57BL/6 wild-type (WT) and transformation-related protein 53 (Trp53) heterozygous knockout (p53KO) mice, as well as a nested case–control study involving 83 women with PB and 82 term birth from a birth cohort on prenatal exposure to BaP and preterm birth (PB). Pregnant WT and p53KO mice were randomly allocated to BaP treatment and control groups, intraperitoneally injected of low (7.8 mg/kg), medium (35 mg/kg), and high (78 mg/kg) doses of 3,4-BaP per day and equal volume of vegetable oil, from gestational day 10.5 until delivery. Results show that high-dose BaP treatment increased the incidence of preterm birth in WT mice. The number of fetal deaths and resorptions increased with increasing doses of BaP exposure in mice. Notably, significant reductions in maternal and birth weights, increases in placental weights, and decrease in the number of livebirths were observed in higher-dose BaP groups in dose-dependent manner. We additionally observed elevated p53-mediated placental apoptosis in higher BaP exposure groups, with altered expression levels of p53 and Bax/Bcl-2. In case–control study, the expression level of MMP2 was increased among women with high BaP exposure and associated with the increased risk of all PB and moderate PB. Our study provides the first evidence of BaP-induced reproductive toxicity and its adverse effects on maternal–fetal outcomes in both animal and population studies.

Fetal deaths from birth defects in Hunan Province, China, 2016–2020

To describe the fetal death rate of birth defects (including a broad range of specific defects) and to explore the relationship between fetal deaths from birth defects and a broad range of demographic characteristics. Data was derived from the birth defects surveillance system in Hunan Province, China, 2016–2020. Fetal death refers to the intrauterine death of a fetus at any time during the pregnancy, including medical termination of pregnancy. Fetal death rate is the number of fetal deaths per 100 births (including live births and fetal deaths) in a specified group (unit: %). The fetal death rate of birth defects with 95% confidence intervals (CI) was calculated by the log-binomial method. Crude odds ratios (ORs) were calculated to examine the relationship between each demographic characteristic and fetal deaths from birth defects. This study included 847,755 births, and 23,420 birth defects were identified. A total of 11,955 fetal deaths from birth defects were identified, with a fetal death rate of 51.05% (95% CI 50.13–51.96). 15.78% (1887 cases) of fetal deaths from birth defects were at a gestational age of < 20 weeks, 59.05% (7059 cases) were at a gestational age of 20–27 weeks, and 25.17% (3009 cases) were at a gestational age of ≥ 28 weeks. Fetal death rate of birth defects was higher in females than in males (OR = 1.25, 95% CI 1.18–1.32), in rural than in urban areas (OR = 1.43, 95% CI 1.36–1.50), in maternal age 20–24 years (OR = 1.35, 95% CI 1.25–1.47), and ≥ 35 years (OR = 1.19, 95% CI 1.11–1.29) compared to maternal age of 25–29 years, in diagnosed by chromosomal analysis than ultrasound (OR = 6.24, 95% CI 5.15–7.55), and lower in multiple births than in singletons (OR = 0.41, 95% CI 0.36–0.47). The fetal death rate of birth defects increased with the number of previous pregnancies (χ2trend = 49.28, P < 0.01), and decreased with the number of previous deliveries (χ2trend = 4318.91, P < 0.01). Many fetal deaths were associated with birth defects. We found several demographic characteristics associated with fetal deaths from birth defects, which may be related to the severity of the birth defects, economic and medical conditions, and parental attitudes toward birth defects.

A decade of analysis describe of maternal and neonatal characteristics of live births in southern Brazil

Introduction: Child health is conditioned by the circumstances of pregnancy, childbirth, and early life. Objective: To describe the maternal and neonatal characteristics of live births (LBs) in the Information System on Live Births of Santa Catarina (SC), Brazil. Materials and methods: A cross-sectional study describedthe maternal and neonatal characteristics of 940,059 LBs, from 2010 to 2019. Pearson’s chi-square test and Fisher’s exact test were conducted, with a statistical significance level of p &lt; 0.05. Results: The mean values of maternal age, number of live children, and number of fetal deaths as well as abortions were 27.1 years, 0.9, and 0.2, respectively. The averages of the number of gestation weeks, number of prenatal consultations, the start date of the prenatal care, and birth weight were 38.5 weeks, 8.1 months, 2.5 monthsand 3,217.1 grams, respectively. Low birth weight (LBW) was prevalent among mothers without education (p &lt; 0.001), including those without prenatal visits (p &lt; 0.001). A higher prevalence of being underweight was observed among female neonates (p &lt; 0.001) and with a maternal age of ≥ 40 years (10.8%; p &lt; 0.001) compared to newborns with good vitality. Newborns with good vitality had a low prevalence of underweight (p &lt; 0.001). The frequency of the variables studied increased, comparing the beginning and end of the period and whether the differences are statistically significant. Conclusions: The study draws attention to the need for interventions to improve the indicators that determine LBW.

Poisson logit hurdle model with associated factors of perinatal mortality in Ethiopia

Perinatal mortality is the total number of fetal death and early neonatal death. Perinatal mortality is a major public health problem, particularly in developing countries, and is used as an implication of the economic, social, and health status of the country. The analysis of count data with hurdle and zero-inflated count models are the most applicable methods to accommodate with excessive zero counts. Therefore, this study aimed to apply the Poisson logit hurdle model to identify the associated factors of perinatal mortality in Ethiopia. A cross-sectional study design was conducted in Ethiopia using EDHS 2016. The sample was multistage stratified and units selected in a two-stage cluster sampling design. The association between the outcome and the independent variables was determined using the Poisson logit hurdle model. A total of 7230 mothers were obtained from EDHS 2016 survey. Of these mothers, 95.27% of them never, 4.47% of them once, 0.26% twice, and 0.04% three times experienced perinatal mortality preceding 5 years of the survey. The main protective associated factors were 40–49 years age of mother, having long preceding birth interval, and secondary + husband education. Parity is greater than four, rural residence, Caesarean section delivery, multiple pregnancies, institutional delivery, having a history of abortion were increased perinatal mortality per mother. This study implies that intervention is needed on family planning and mode of delivery to minimize perinatal mortality in the country.

Nationwide study of mortality and survival in pregnancy-related streptococcal toxic shock syndrome.

Streptococcal toxic shock syndrome is associated with the highest infection-related maternal mortality rates. We conducted a comparative analysis of the background factors and treatment course between survivors and nonsurvivors to improve our understanding concerning the optimal initial treatment approach for this fulminant disease. This retrospective observational study was conducted based on clinical data collected from two national organizations. Clinical data of patients who died or survived (i.e. background information, clinical course and treatment administered) were collected. Records of 13 dead and 15 surviving patients were collected and analyzed. No statistically significant differences were found between the groups regarding age, parity, season, gestational age or the patients' location at the onset of symptoms. After the initial symptom onset, the survivors received antibiotics more systematically during their first visit to a clinic (P = 0.006). More survivors had received treatment within 1 h of onset of fulminant disease (P = 0.069). The number of fetal deaths was significantly higher in the mortality group (P = 0.003), while the fetal survival number was higher in the group of maternal survivors (P = 0.055). Maternal survivors with nonspecific initial symptoms received early intervention when there was a family history of group A streptococcal infection or a positive rapid antigen test result. Intensive care, including systemic antibiotic administration, may contribute to maternal survival when administered immediately (within 1 h) after the fulminant streptococcal toxic shock syndrome onset. Eliciting a family history of streptococcal infection and conducting a rapid antigen test can identify the patients needing early intervention.

Comparison of Standard Conservative Treatment and Early Initiation of Renal Replacement Therapy in Pregnancy-related Acute Kidney Injury: A Single-center Prospective Study.

Introduction and objectivePregnancy-related acute kidney injury (PRAKI) is one of the most important cause of maternal and fetal morbidity and mortality. Some of the reasons behind PRAKI may be due to sepsis, postpartum hemorrhage, preeclampsia, thrombotic microangiopathies (TMA), and acute fatty liver of pregnancy (AFLP). The timing of initiation of renal replacement therapy (RRT) for better patient outcome is still debatable. We conducted this study to establish whether earlier initiation of RRT in PRAKI improves fetomaternal survival compared to a more conservative approach.Materials and methodsThis is a prospective study, where patients were screened at a multispecialty tertiary care hospital in north India for 1 year. The patients were divided into two groups: early RRT and standard AKI treatment. The demographic profile and clinical characteristics of the patients in terms of age, parity access to antenatal care, fetal outcome, urine output, hematological and biochemical profiles, RRT, duration of hospitalization, recovery of renal function, and patients survival were recorded.ResultsThis prospective study conducted included 13 patients in the early RRT group and 23 patients in the standard group. Considering the fetal outcome, the number of fetal deaths in early RRT group were 14.29%, whereas for the standard group it was 85.71%. In all, 75% of early RRT group and 25% of standard group had normal term delivery. Probability test applied showed they were statistically significant. One maternal mortality was there in the standard group. The indices of maternal outcome in PRAKI patients were found to be statistically insignificant.ConclusionThe planning of RRT whether early or late does not make a difference in maternal mortality or morbidity. The fetal outcome is significantly better for patients with early RRT than conservative treatment in PRAKI.How to cite this articleBanerjee A, Mehrotra G. Comparison of Standard Conservative Treatment and Early Initiation of Renal Replacement Therapy in Pregnancy-related Acute Kidney Injury: A Single-center Prospective Study. Indian J Crit Care Med 2020;24(8):688–694.

Prevalence of pre-gestational and gestational smoking and factors associated with smoking cessation during pregnancy, Brazil, 2011-2012.

Gestational smoking is associated with various adverse maternal and fetal outcomes. Over the last three decades, despite considerable advances in tobacco control policy in Brazil, gestational smoking has caused a considerable number of fetal deaths and disabilities. The aim of this study is to estimate the prevalence of pre-gestational and gestational smoking and to identify the factors associated with smoking cessation up to the 20th gestational week. Methods: “Birth in Brazil” was a nationwide hospital-based study conducted from February 2011 to October 2012. Smoking prevalence and smoking cessation during pregnancy was estimated through face-to-face interviews with postpartum women during hospitalization for birth care. We performed multivariate logistic regression to verify the factors associated with smoking cessation up to the 5th month of pregnancy. Results: prevalence of pre-gestational smoking of 16.1% (CI 95% 15.3%-16.9%); prevalence of smoking any time during pregnancy of 9.6% (CI 95% 9.0%-10.3%); and prevalence of smoking cessation up to the 5th month of pregnancy of 56.7% (CI 95% 54.0%-59.4%). The factors associated with smoking cessation were residence in the North, Northeast, and Central-West of Brazil, having received at least one prenatal consultation (OR 3.51 CI 95% 1.85–6.67), more years of schooling (15 or more vs less than 7 years of schooling OR 5.54 CI 95% 2.97–10.34), living with a partner (OR 1.35 CI 95% 1.01–1.79), no children prior to the index pregnancy (OR 2.77 CI 95% 2.13–3.61), and absence of alcohol use (1.74 CI 95% 1.39–2.18) or of suspected alcohol abuse (OR 1.62 CI 95% 1.07–2.45). Conclusion: The estimated smoking rate during pregnancy in Brazil is still high and is associated with factors of increased maternal social vulnerability, which may contribute to the increased occurrence of unfavorable perinatal outcomes.

An Overview of Reviews on the Safety of Electroconvulsive Therapy Administered During Pregnancy.

To inform obstetricians and psychiatrists about the safety of electroconvulsive therapy (ECT) administration during pregnancy and to reconcile conflicting recommendations concerning this treatment. A systematically conducted overview was undertaken on the safety of ECT during pregnancy. The Cochrane Library, MEDLINE/PubMed, PsycINFO, and Ovid were independently searched by 2 of the authors from January 2015 to March 2017 using the following search terms: electroconvulsive therapy, ECT, and electroshock combined with pregnancy and reviews. Articles were reviewed and critically appraised using components of the PRISMA and AMSTAR systematic review assessment tools. Of the 9 articles that were identified, 5 publications of varying methodological quality met inclusion criteria and involved a range of 32 to 339 patients. The most common problems that occurred in association with ECT were fetal arrhythmia, fetal bradycardia, premature birth, developmental delay, abdominal pain, uterine contraction, vaginal bleeding, placental abruption, and threatened abortion. The number of fetal deaths in each of the reviews ranged from 2 to 12. The authors of 1 of the 5 reviews recommended that ECT only be used as a last resort, whereas the authors of the other reviews took the stance that the administration of ECT during pregnancy was relatively safe. Differences in recommendations among reviews were in part due to inclusion criteria and how adverse events were attributed to ECT. Our overview supports the conclusion, which has also been endorsed by the American College of Obstetricians and Gynecologists and the American Psychiatric Association, that administration of ECT during pregnancy is relatively safe. Conclusions about safety, however, will become better established with the availability of more data.

Use of efavirenz during the first trimester and resulting pregnancy outcome: experience of the Ambulatory Treatment Center of Brazzaville

BackgroundThe aim of this study is to report the experience of the Ambulatory Treatment Center of Brazzaville regarding the use of efavirenz (EFV) during pregnancy.MethodsA retrospective cohort study of HIV‐positive women was conducted at the Ambulatory Treatment Center of Brazzaville. The study examined the use of an anti‐retroviral treatment containing EFV in women who reported being pregnant during follow‐up between January 2009 and September 2011. Demographic, clinical and biological data, and adverse effects associated with exposure to EFV during pregnancy were assessed after each pregnancy from the register of pregnant women in terms of preterm delivery (birth occurring before 37 weeks of age) and spontaneous miscarriage (spontaneous expulsion of the fetus before 15 weeks of age).ResultsOf 220 patients on an anti‐retroviral treatment who reported being pregnant during follow‐up, 34 patients were administered combinations containing two nucleoside reverse transcriptase inhibitors (AZT/3TC=27; d4T/3T=4; TDF/FTC=3) and EFV, with a median age of 31.95 years (IQR: 27.71–36.37) and median durations of exposure to EFV of 11.81 months (IQR: 5.46–21.22) and 35.14 weeks (IQR: 11–39.86) before and during pregnancy, respectively. In 13 patients who reported to be in their first trimester of pregnancy, a change from EFV to nevirapine was made in nine of these patients. The median CD4 count was 271.5 cells/mm3 (IQR: 233.5−414.5) and 305 cells/mm3 (IQR: 205–408) in early pregnancy and at delivery, respectively; the viral load was undetectable in 90% and 85.7% of the patients, respectively. Twenty‐three deliveries took place after 37 weeks gestation; additionally, five preterm deliveries, four spontaneous miscarriages, one terminated pregnancy, and one death in utero occurred.ConclusionsEFV used during the first trimester of pregnancy offers security, but the number of fetal deaths is also important.

Single embryo transfer reduces the risk of perinatal mortality, a population study

Do births following single embryo transfers (SET) have a reduced risk of perinatal mortality compared with those following double embryo transfers (DET)? SET is associated with reduced risk of perinatal mortality compared with DET. Fetal, neonatal and perinatal mortality are important indicators for monitoring pregnancy and childbirth, particularly for births following assisted reproductive technology (ART) treatments. Following the introduction of SET, there has been a decline in the perinatal mortality rate (PMR) among babies born after ART in Australia and New Zealand. This population study (census) included 50,258 births of ≥ 20 weeks gestation and/or ≥ 400 g of birthweight following embryos transfer cycles in Australia and New Zealand during the period 2004-2008. The PMR was calculated according to the number of embryos transferred and other demographic and treatment-related factors. Perinatal deaths were defined as the number of fetal deaths (stillbirths) plus the number of neonatal deaths (deaths that occur before 28 days after birth). The PMR was 16.2 per 1000 births (n= 813). Of the 813 perinatal deaths, 630 were fetal deaths and 183 neonatal deaths. Twins had a significantly higher PMR (27.8 per 1000 births) than singletons (12.4 per 1000 births). The risk of perinatal mortality for all births following DET was 53% higher than for all births following SET (adjusted risk ratio 1.53, 95% confidence interval (95% CI): 1.29-1.80). Births following fresh DET had a 58% increased risk of perinatal mortality compared with births following fresh SET (risk ratio 1.58, 95% CI: 1.32-1.90). Information on outcomes was missing from <1% of clinical pregnancies recorded in Australian and New Zealand Assisted Reproduction Database for the study period. There are no data on the timing of fetal death, the cause of perinatal death or on late termination of pregnancy at ≥ 20 weeks' gestation. Double and higher order embryo transfer is associated with a higher risk of perinatal mortality when compared with SET. The number of embryos transferred is determined by the clinician with consent of the patient and is a modifiable treatment factor. SET should be advocated as the first-line management in ART as it is the single most effective public health intervention for preventing excess perinatal mortality among ART pregnancies. Nil.

Shift in the Sexes: Are Endocrine Disruptors Changing Birth Ratios?

According to demographic data compiled by the United Nations, an average of 105 boys are born for every 100 girls. The male proportion of births, equal to 0.515, varies slightly between years and populations, but these factors do not fully explain consistently shifting ratios in several industrialized countries over recent decades. A new study examines birth and fetal death sex ratios in Japan and the United States and reveals significant male-to-female shifts in both nations [EHP 115:941–946; Davis et al.]. The research team calculated birth and fetal death sex ratios in Japan based on 1949–1999 data from the Japanese Vital Statistics Bureau. The proportion of male births varied yearly before 1970 but declined steadily since then, from 0.5172 to 0.5135. Between 1960 and 1999, the male proportion of fetal deaths increased from 56% to 67.7%. The male fetal death rate is approximately four times higher in Japan than in the United States. For U.S. calculations, the researchers drew 1983–1995 fetal death data and 1970–2002 birth data from the National Center for Health Statistics. The proportion of male births dropped in the United States, from 0.5134 in 1970 to 0.5117 in 2002. There are significant racial differences, however: between 1970 and 2002 the proportion of non-Hispanic white male births fell from 0.5143 to 0.5122, whereas the proportion of black male births rose slightly from 0.5076 to 0.5079. The male proportion of black fetal deaths also increased, rising from 53.5% to 54.5%; among whites, the male proportion of fetal deaths rose by less than 0.5%. Why birth sex ratios differ so much between white and black women is unknown, but hormonal differences due to race and to incidence of obesity may be involved. A possible explanation for the increased ratio among black births may stem from improved prenatal and obstetric care in general, reducing the overall number of fetal deaths. The researchers speculate that parental exposures to endocrine-disrupting chemicals, including metalloestrogens such as methylmercury, might be factors undermining the conception and survival of male children. They suggest particular scrutiny of Japanese body burden of mercury and other metalloestrogens to understand this difference. Additionally, future investigations of declining sex ratios should consider the types and timing of prenatal and parental exposures to endocrine-disrupting chemicals. The researchers hypothesize that paternal exposures prior to conception might affect expression of the SRY gene on the Y chromosome.

Evaluation of the toxic potentials of a new camptothecin anticancer agent CKD-602 on fertility and early embryonic development in rats

This study examined the potential adverse effects of a new camptothecin anticancer agent, CKD-602, on the fertility and early embryonic development of Sprague–Dawley rats. Ninety-six rats of each gender were divided into four groups: three treatment groups and a control group. CKD-602 was administered intravenously to male rats at 0, 4.7, 14, and 42 μg/kg from 63 days prior to mating until the end of the mating period, and to female rats from 14 days before mating until day 6 of gestation. All the males were sacrificed after the end of the 14-day mating period, while all the females were subjected to a caesarean section on day 15 of gestation. In the high dose group, a high incidence of hair loss was observed in both genders. A decrease in the level of food consumption, followed by a decrease in body weight gain was also observed in both genders. At the scheduled necropsy, the gross postmortem examinations revealed an increase in the incidence of thymic atrophy, paleness of the thoracic and abdominal organs in both genders and an increase in the serum testosterone concentration. In addition, there was a decrease in the thymus weight of the males and an increase in the liver, spleen, kidneys, lung, and heart weights of the females. There was an increase in the number of fetal deaths and post-implantation losses as well as a decrease in the litter size found at the caesarean section of the dams. No treatment-related effect on the histopathological findings, sexual cycle, pre-coital time, mating index, fertility index, pregnancy index, and sperm parameters was observed. There were no adverse effects on the general findings and reproductive performance of the parent animals and early embryonic development in the low and medium dose groups. Overall, the no-observed-adverse-effect levels (NOAELs) of CKD-602 are believed to be 14 μg/kg for both general toxicity and early embryonic development, and more than 42 μg/kg for the reproductive performance of the parent animals.

Perinatal mortality rate in relation to gender.

To calculate the gross and gender adjusted perinatal mortality rate (PMR) and determine the association between gender and susceptibility towards perinatal death. A cross-sectional hospital-based study conducted at Gynae Unit-I of Bolan Medical Complex Hospital, Quetta from 1st January to 31st December, 2002. The study included the total births and perinatal deaths over one year period. The cause of death was ascertained through specifically-designed questionnaires and external autopsy. PMR was defined as the number of fetal deaths from 28 weeks of gestations to early neonatal deaths within 7 days after birth. Birth weight of >1000 grams or 35 cms crown-heel length was considered in lieu of unknown gestational age. Multiple pregnancies and stillbirths occurring at home were excluded. Extended Wiggles Worth classification was used to study the etiology of perinatal death separately. The PMR was calculated to be 113 per 1000 births. Stillbirth rate was 103 per 1000 total births; out of these, 56.5% were intrapartum and 43.3% antepartum. Male stillbirths were 89.24% in intrapartum and 62.5% in antepartum (df=1,X2=16, p < 0.001). Out of 16 early neonatal deaths, 11 were male infants. Aberdeen classification revealed obstetric causes of PMR as antepartum haemorrhage (34 cases;76% males), malpresentations (28 cases; 57% males), and congenital anomalies (26 cases; 80% males), after adjusting for maternal age and parity. This study shows fetal gender as statistically significant risk factor and it will pave the way for future community-based studies to confirm such an association, after adjusting for other co-variables.

Parents' age at birth of their offspring and child survival.

This study presents some new results on parental age as a risk factor for child survival. The study is based on individual registration forms for live births and infant deaths collected in Hungary from 1984 to 1988. Logistic regression models have been fitted for early neonatal and neonatal mortality on the one hand, and post-neonatal mortality on the other hand. Children of older males and females have significantly higher early neonatal and neonatal mortality rates compared to those of younger males and females. The impact of age of both parents remains, however, slighter than that of other biological characteristics such as previous number of fetal deaths, induced abortions, or live births. The authors discuss possible biological explanations.

The effect of treatment of twin-twin transfusion syndrome on the diagnosis-to-delivery interval.

No randomised controlled trials of treatment of twin-to-twin transfusion syndrome (TTTS) exist. Since severely preterm neonatal survival has increased over time, survival as an outcome measure is confounded by improvements in neonatal care. The diagnosis-to-delivery interval is a measure of success of treatment independent of improvements in neonatal care. We wished to evaluate whether treatment of TTTS is associated with a lengthening of the diagnosis-to-delivery interval. MEDLINE search was performed supplemented by careful reference review. All TTTS series were included where the following information on each patient was available: survival, fetal demise, gestational age at diagnosis and diagnosis-to-delivery interval in days. gestational age at diagnosis < 29 weeks and diagnosis by ultrasound in the absence of maternal symptoms. Cases undergoing multiple types of treatment were excluded. Eight publications met inclusion criteria and included the following cases: controls (n = 16), amnioreduction (n = 61), septostomy (n = 12), and fetoscopic laser occlusion of chorioangiopagus vessels (n = 51). There was no difference in the diagnosis-to-delivery interval, overall survival, at least one survivor, or number of fetal deaths between the four groups. Logistic regression using at least one survivor as the dependent variable revealed a positive association with gestational age at diagnosis and with diagnosis-to-delivery interval, a negative correlation with fetal death, and no correlation with treatment group. We conclude that there is no difference in diagnosis-to-delivery interval or survival for any treatment for TTTS compared to expectant management. The lack of significance appears to be due to small sample sizes.

The Effect of Treatment of Twin-Twin Transfusion Syndrome on the Diagnosis-to-Delivery Interval

AbstractNo randomised controlled trials of treatment of twin-to-twin transfusion syndrome (TTTS) exist. Since severely preterm neonatal survival has increased over time, survival as an outcome measure is confounded by improvements in neonatal care. The diagnosis-to-delivery interval is a measure of success of treatment independent of improvements in neonatal care. We wished to evaluate whether treatment of TTTS is associated with a lengthening of the diagnosis-to-delivery interval. MEDLINE search was performed supplemented by careful reference review. All TTTS series were included where the following information on each patient was available: survival, fetal demise, gestational age at diagnosis and diagnosis-to-delivery interval in days. Inclusion criteria: gestational age at diagnosis &lt; 29 weeks and diagnosis by ultrasound in the absence of maternal symptoms. Cases undergoing multiple types of treatment were excluded. Eight publications met inclusion criteria and included the following cases: controls (n = 16), amnioreduction (n = 61), septostomy (n = 12), and fetoscopic laser occlusion of chorioangiopagus vessels (n = 51). There was no difference in the diagnosis-to-delivery interval, overall survival, at least one survivor, or number of fetal deaths between the four groups. Logistic regression using at least one survivor as the dependent variable revealed a positive association with gestational age at diagnosis and with diagno-sis-to-delivery interval, a negative correlation with fetal death, and no correlation with treatment group. We conclude that there is no difference in diagnosis-to-delivery interval or survival for any treatment for TTTS compared to expectant management. The lack of significance appears to be due to small sample sizes.

WS13: Multiple pregnancy WS13‐01The effect of treatment of twin‐to‐twin transfusion syndrome on the diagnosis to delivery interval

PurposeNo randomized controlled trials of treatment of twin‐to‐twin transfusion syndrome (TTTS) exist. Since severely preterm neonatal survival has increased over time, survival as an outcome measure is confounded by calendar time. The diagnosis‐to‐delivery interval is a calendar year independent measure of success of treatment. We wished to evaluate whether treatment of TTTS is associated with a lengthening of the diagnosis‐to‐delivery interval.MethodsMEDLINE search supplemented by careful reference review. All TTTS series were included where the following information on each patient was available: survival, fetal demise, gestational age (GA) at diagnosis and diagnosis to delivery interval in days.Inclusion criteriaGA ≤ 29 weeks and diagnosis by ultrasound in the absence of maternal symptoms. Cases undergoing multiple types of treatment were excluded. Data were evaluated by Kruskal–Wallis anova, logistic regression &amp; Wilcoxon rank sum testing.ResultsThe 8 publications used included the following cases: controls (n = 16), amnioreduction (n = 61), septostomy (n = 12), and fetoscopic laser occlusion of chorioangiopagus vessels (FLOC) (n = 51). FLOC therapy showed a significantly longer diagnosis‐to‐delivery interval compared to amnioreduction (median 75 vs. 56 days) (p = 0.01). There was no difference in overall survival, at least one survivor, or number of fetal deaths between the 4 groups. Logistic regression using at least one survivor as the dependent variable revealed a positive association with GA at diagnosis and with diagnosis to delivery interval, a negative correlation with fetal death, and no correlation with treatment group.ConclusionsFLOC therapy for TTTS is associated with a longer diagnosis‐to‐delivery interval compared to amnioreduction without a significant increase in survival. The lack of increase in survival appears to be due to a small sample size.

Electronic fetal monitoring: how necessary?

Intrapartum hypoxia causes about 30% of cerebral palsy and 10% of severe mental retardation, according to recent estimates. It is also responsible for an undetermined number of fetal deaths. Decreases in the oxygen supply can often be detected before it is too late by changes in the fetal heart rate; auscultation of the fetal heart rate with a fetal stethoscope has been done for years. However, studies have shown this method to be subject to error at extremely high and low rates—precisely where it is most important to be accurate. Hence, work began in the late 1950s to design an electronic means of quantitating the fetal heart rate. The technique has developed and expanded rapidly. As now practiced, electronic monitoring involves either placing electrodes on the fetus' scalp to record the ECG or measuring fetal heartbeat with an ultrasonic transducer placed on the mother's abdomen. Simultaneous measurement of uterine contractions

The effect of anti-inflammatory drugs on parturition parameters in the rat

Four anti-inflammatory drugs, 3 acid non steroid and one steroid, and an hypnotic drug were administered orally to pregnant rats during the 19th to 21st day of gestation and their effect on time of onset of parturition (TOP), duration of parturition (DOP), bleeding during parturition and perinatal mortality were noted. Our results indicate that acetylsalicylic acid, salicylic acid, and cortisone acetate (in high dosage) all delay significantly the (TOP) when compared to controls. Sodium salicylate and cortisone acetate (in small doses) did not delay the TOP. The acid non steroids prolong the parturition time, DOP, but the cortisone treated rats have the same DOP as the controls. A marked increase of bleeding at parturition was evident in the acid non steroid treated group with only a slight increase in the cortisone treated group. The acetylsalicylic acid (2 day treated), salicylic acid, and cortisone treated rats showed no increase in the number of pups born dead/total pups, but the sodium salicylate and acetylsalicylic acid (3 day treated) rats showed an increase in the number of fetal deaths. Phenobarbital had no effect on the TOP, DOP, bleeding during parturition nor the number of pups born dead to total pups delivered when compared to controls. Extrapolation of the data to human gestations warrants a cautious approach to consumption of these drugs by pregnant women at or near term. Further, the significance of the usage of these drugs for prevention of pregnancy wastage as obtains with spontaneous abortion and prematurity should not be overlooked.

Letters to the Editor

Dr. Brewer has apparently confused the term perinatal mortality rate, usually defined as the number of fetal deaths during the first week before delivery plus the neonatal deaths during the first week after delivery, per 1,000 live births, with infant mortality, deaths of live born infants during the first year of life, per 1,000 live births.: Both rates have considerable importance and utility but they are quite different. The National Center for Health Statistics has validated the general reliability of the 10% sample as reflecting very closely the final and correct data, which are usually not available until one or two years later.