Perinatal Infant Mortality Research Articles

Dolutegravir in late pregnancy: where to from here?

Strategies to eliminate the perinatal transmission of HIV include initiation of effective antiretroviral therapy (ART) as soon as possible before or during pregnancy and maintaining a suppressed viral load throughout pregnancy and postpartum. Late initiation of ART in pregnant women with HIV has been associated with increased risk of perinatal transmission and perinatal mortality in infants.1 In the DolPHIN-2 study,2 268 pregnant women with HIV (median gestational age 31 weeks) from Cape Town, South Africa and Kampala, Uganda, were enrolled and randomly assigned to receive either dolutegravir-based or efavirenz-based ART.

Frequency and Prognosis of Hydrops Fetalis: A 10-Year Single-Center Experience.

Objective:The study aims to evaluate the etiological distribution and prognosis of newborn infants with hydrops fetalis (HF).Methods:All infants born in our hospital within the past 10 years and hospitalized with the diagnosis of HF were included in this retrospective descriptive study. Demographic characteristics, etiological distributions, treatment interventions, and prognosis information of the infants were recorded retrospectively. Infants with incomplete data were excluded from the study.Results:The mean gestational age of infants with HF was 33.6±3.1 weeks, and the mean birth weight was 2444±792 grams. Of the HF cases, 90.5% were born by cesarean section and the prenatal diagnosis rate was 42.9%. About 57.1% of the infants were intubated during resuscitation at birth in the delivery room. In the NICU, 81% of the cases were intubated and 71.4% received surfactant treatment. The most common HF findings were ascites (81%) and subcutaneous edema (81%). The most common interventional procedures were paracentesis (81%) and thoracentesis (52.4%). Exchange transfusion was performed in 2 cases (9.5%) due to immune HF. The mortality rate in the study group was 52.4%. Considering the etiological distribution of HF cases in the study group, three cases were diagnosed with immune HF (14.3%) and 18 cases with non-immune hydrops fetalis (NIHF) (85.7%). The underlying cause in immune HF cases was rhesus incompatibility. In cases with NIHF, idiopathic (23.8%) and cardiovascular diseases were the most common etiologies. A significant relationship was found between delivery room management and mortality. While the need for intubation in delivery room was significantly higher in non-survivors, the frequency of applying only positive pressure ventilation in the delivery room was significantly higher in survivors. While the rate of survival was 66.7% in immune HF cases, it was 44.4% in NIHF cases.Conclusion:The risk of perinatal mortality in infants with HF is high depending on the underlying cause. In this study, it was determined that HF mostly developed for non-immune reasons, prenatal diagnosis and follow-up were insufficient and the interventions performed in the delivery room were an important factor in predicting mortality in the follow-up of neonates with HF.

The Epidemiological, Clinical and Therapeutical Aspects of the Vesico-vaginal Fistula at the National Fistula Treatment Center in N'Djamena

The objective of our study was to report on the epidemiological and etiopathogenic aspects of obstetric fistulas and to evaluate the results of their management at the National Fistula Treatment Centre in N'Djamena (Chad). Patients and Methods: This was a retrospective, descriptive study conducted at the National Fistula Treatment Centre in N'Djamena over a 4-year period from January 2012 to December 2016. Results: The mean age of our patients was 26.38 years with extremes of 12 to 74 years. The majority of our patients were young women aged 12 to 22 years. Of the patients 82.5% resided in rural areas. They were housewives in 88.9% and victims of genital mutilation in 76.8%. 73.6% did not have a prenatal consultation. A vaginal delivery was recorded in 74.9%. Perinatal infant mortality was recorded in 83.2%. Spinal anaesthesia was used in 95.7% of cases. The repair by low way in 93.7%. The success rate in a so-called first-hand fistulas was noted in 88.88%. Conclusion: Obstetrical fistulas is a real public health problem in our countries. Women with fistula are victims of all forms of social exclusion. The most effective means of combating it remains prevention and access to emergency obstetric care.

Characteristics overview of mother with perinatal death at Dr. Soetomo Hospital in 2015

Objectives: to determine the frequency distribution of perinatal mortality and maternal characteristic features in terms of age, parity, gestational age and pregnancy complications in Dr.Soetomo Hospital Surabaya in 2015. Materials and Methods: A descriptive study conducted by collecting data on patients who experienced perinatal mortality of infants born from January to December 2015 in Dr. Soetomo, Hospital Surabaya. Samples were collected using total sampling. The samples must meet the following criteria: mothers of infants with perinatal mortality in Dr. Soetomo Hospital, Surabaya, from January to December 2015.Results: There were 206 perinatal deaths out of 1018 births in Dr. Soetomo during 2015, of which 58% was live birth and 42% was stillbirth. Most of perinatal mortality found in the preterm gestational age as much as 78%, and gestational age 28-<37 weeks (58%). Most of perinatal mortality occured in infants with less than 1500 grams birth weight, which was as much as 53% of all perinatal deaths and infant whose birth weight from1500 to 2500 grams was about 29%. Most perinatal mortality found in multigravida (54%) and in infants whose mothers experienced preeclampsia in pregnancy complications (35%), followed by infant mortality in women with non-obstetric complications (23%).Conclusion: Perinatal mortality in Dr. Soetomo Hospital was mostly found in multigravida mothers, 16-35 years old maternal age, 28-37 weeks gestational age and those with complications of preeclampsia.

Characteristics overview of mother with perinatal death at Dr. Soetomo Hospital in 2015

Objectives: to determine the frequency distribution of perinatal mortality and maternal characteristic features in terms of age, parity, gestational age and pregnancy complications in Dr.Soetomo Hospital Surabaya in 2015. Materials and Methods: A descriptive study conducted by collecting data on patients who experienced perinatal mortality of infants born from January to December 2015 in Dr. Soetomo, Hospital Surabaya. Samples were collected using total sampling. The samples must meet the following criteria: mothers of infants with perinatal mortality in Dr. Soetomo Hospital, Surabaya, from January to December 2015.Results: There were 206 perinatal deaths out of 1018 births in Dr. Soetomo during 2015, of which 58% was live birth and 42% was stillbirth. Most of perinatal mortality found in the preterm gestational age as much as 78%, and gestational age 28-<37 weeks (58%). Most of perinatal mortality occured in infants with less than 1500 grams birth weight, which was as much as 53% of all perinatal deaths and infant whose birth weight from1500 to 2500 grams was about 29%. Most perinatal mortality found in multigravida (54%) and in infants whose mothers experienced preeclampsia in pregnancy complications (35%), followed by infant mortality in women with non-obstetric complications (23%).Conclusion: Perinatal mortality in Dr. Soetomo Hospital was mostly found in multigravida mothers, 16-35 years old maternal age, 28-37 weeks gestational age and those with complications of preeclampsia.

Abdominal Wall Defects in Greenland 1989–2015

In the last decades, an increasing rate of gastroschisis but not of omphalocele has been reported worldwide. Greenland is the world's largest island, but 80% is covered by an ice cap, it has a small population of around 56,000 peoples (as of 2016). The occurrence of abdominal wall defects has never been investigated in Greenland. The present study is based on data retrieved from three nationwide and two local registries in the Greenlandic health care system over 27 years (1989-2015). We identified 33 infants with abdominal wall defects born in the study time period. All cases were reclassified to 28 cases of gastroschisis, four cases of omphalocele, and there was 1 infant in the indeterminate group. The point prevalence at birth for gastroschisis increased significantly from 8 to 35 (average 10.7) per 10,000 liveborn and -stillborn infants. Mothers below 20 years of age represented 23% of all cases and the prevalence for this group was 17 per 10,000 liveborn and stillborn. Perinatal mortality for infants with gastroschisis was high (18%), and 1 year survival was 71%. For omphalocele, the prevalence varied from 8 to 11 per 10,000 liveborn and stillborn infants. There was no increasing rate in the period, further highlighting an etiological difference between gastroschisis and omphalocele. This study confirms the increasing prevalence of gastroschisis in Greenland in the period from 1989 to 2015. The average was 10.7 per 10,000 liveborn and -stillborn infants and, to the best of our knowledge, this is the highest prevalence ever reported. Birth Defects Research 109:836-842, 2017. © 2017 Wiley Periodicals, Inc.

Piezo2 senses airway stretch and mediates lung inflation-induced apnoea.

Respiratory dysfunction is a notorious cause of perinatal mortality in infants and sleep apnoea in adults, but the mechanisms of respiratory control are not clearly understood. Mechanical signals transduced by airway-innervating sensory neurons control respiration; however, the physiological significance and molecular mechanisms of these signals remain obscured. Here we show that global and sensory neuron-specific ablation of the mechanically activated ion channel Piezo2 causes respiratory distress and death in newborn mice. Optogenetic activation of Piezo2+ vagal sensory neurons causes apnoea in adult mice. Moreover, induced ablation of Piezo2 in sensory neurons of adult mice causes decreased neuronal responses to lung inflation, an impaired Hering-Breuer mechanoreflex, and increased tidal volume under normal conditions. These phenotypes are reproduced in mice lacking Piezo2 in the nodose ganglion. Our data suggest that Piezo2 is an airway stretch sensor and that Piezo2-mediated mechanotransduction within various airway-innervating sensory neurons is critical for establishing efficient respiration at birth and maintaining normal breathing in adults.

Intervention Improved Health Workers’ Neonatal Resuscitation Skills and Knowledge, but Not Neonatal Mortality

Health care workers who participated in a mobile phone-based safe delivery intervention had greater skills and knowledge regarding neonatal resuscitation than control workers, according to a cluster-randomized clinical trial conducted at 70 health care facilities in rural Ethiopia. (1) Neonatal resuscitation skills scores six months and 12 months after implementation of the safe delivery app intervention were higher among intervention health care workers than among controls (mean differences, 6.0 and 8.8 points, respectively); neonatal resuscitation knowledge was higher among intervention health care workers than among controls at six months postimplementation (mean difference, 1.7 points), but not at 12 months. The intervention was not associated with a significant change in perinatal mortality of infants delivered at study health care facilities. The safe delivery app was designed to provide health care workers in low-income countries with the knowledge and skills to manage obstetric and neonatal emergencies; the app consisted of videos on topics such as neonatal resuscitation, as well as a catalog of essential obstetric drugs and equipment. To examine whether use of the app was associated with changes in perinatal mortality rates and in health care workers' knowledge and skill levels, researchers conducted a cluster-randomized clinical trial of health care facilities in five rural districts of Ethiopia's Oromiya region. Of the 131 facilities that were screened, 70 met the study's eligibility criteria (i.e., having a midwife or health extension worker on staff and having been the site of deliveries in the previous year) and were included in the study sample. Half of eligible facilities were randomly selected to the intervention group and were supplied with smartphones loaded with the safe delivery app; health care workers at intervention facilities received a one-day training session on how to use the phones and app. The other half of facilities were selected to the control group, and did not receive phones or additional training; the researchers ensured that both intervention and control facilities had an adequate package of drugs and equipment. Between September 2013 and February 2015, data were collected on women delivering at study facilities and on their birth outcomes; women were contacted in person or by phone seven days after delivery to follow up about perinatal mortality. In addition, facility health care workers' knowledge and skills regarding neonatal resuscitation were assessed by questionnaire and structured assessment tools (e.g., simulated scenarios using mannequins) before implementation of the intervention and at six and 12 months afterward. Descriptive and logistic regression analyses were used to compare perinatal mortality rates at intervention and control facilities, and to compare health care workers' neonatal resuscitation knowledge and skills index scores over time. The analysis sample included 1,474 women in the intervention group and 1,665 in the control group. Most women in each group (>85%) reported being younger than 29, having a primary or lower education and being a housewife; more than one-third of women in each group were pregnant for the first time. …

Mechanistic studies in swine to evaluate newborn infant vitamin A dosing strategies (260.1)

Clinically, infant care is challenging especially in resource‐poor developing countries where small‐for‐gestational‐age is common and in any country when an infant is born prematurely. Several components comprise perinatal mortality of infants. Children suffering from vitamin A deficiency have a greater risk of irreversible blindness and dying from infectious diseases. Supplementation programs are an approach to address this issue. Studies have found little or no improvement in infant vitamin A status after supplementing with 25,000 IU vitamin A. Based on WHO’s recommendations, children ages 6 ‐ 11 mo receive 100,000 IU vitamin A and those 12 ‐ 59 mo receive 200,000 IU vitamin A every 4 to 6 mo. Multi‐centered and randomized trials of infant supplementation programs have shown inconsistent results. Infant supplementation itself has been debated due to the higher incidence of bulging fontanelle in vitamin A‐dosed infants. Therefore, a series of studies were performed in a swine model to evaluate infant dosing regimens. Newborn piglets from vitamin A‐depleted sows received a placebo, 25,000, 50,000, or 200,000 IU vitamin A supplements at birth. Tissues were collected and analyzed. The degree of vitamin A deficiency did not seem to affect the response to treatment. High doses may be quickly catabolized to maintain balance. Lung and spleen require chylomicron vitamin A to maintain concentrations, which was confirmed with a tracer study using α‐retinol. The tracer study also showed quick uptake in the adrenal gland. Low birth weight piglets took up less vitamin A. Food sources of vitamin A performed better than supplementation at improving vitamin A status of offspring.Grant Funding Source: Supported by the Nutrition Unit at the World Health Organization.

Increasing rates of operative vaginal delivery across two decades: accompanying outcomes and instrument preferences

ObjectiveTo examine rates and outcomes of operative vaginal delivery over a 20-year study period and the changing preference for various instruments during this period. Study designThis retrospective analysis of prospectively gathered data was carried out at a large tertiary referral center from 1991 to 2010. All cases of operative vaginal delivery during the study period were recorded. The rates of instrumental delivery, as well as neonatal outcomes and instrument preference, were compared for individual 5-year epochs. ResultsDuring the study period there were 156,130 deliveries of which 17,841 were operative vaginal deliveries, an incidence of 11.4/100 deliveries and 13.6/100 vaginal deliveries. There was an increase in the rate of operative vaginal delivery across the 20-year period (P<0.0001; R2=0.85; Slope=0.42). When individual 5-year epochs were compared, the incidence of instrumental delivery increased from 7.3% (2340/31,937) in the first five years, 1991–1995, to 13.7% (6179/45,177) in the final five years, 2006–2010 (P<0.0001; OR 2.34, 95% CI=2.23–2.47). The perinatal mortality rate in cases of instrumental delivery was decreased when these time periods were compared (7.3/1000 (17/2340) vs. 1.8/1000 (11/6179); P=0.003, OR 0.24, 95% CI=0.11–0.52). The choice of instrument also varied, with 68.2% (1596/2340) of instrumental deliveries in 1991–1995 being carried out with forceps compared to 32.9% (2033/6179) in 2006–2010 (P<0.001). ConclusionRates of operative vaginal delivery have increased over the 20-year study period. The rate of perinatal mortality in infants who had an assisted vaginal delivery was decreased in the 5-year epoch at the end of the study compared with the period at the beginning. The rate of forceps delivery has fallen significantly, with vacuum delivery now being the choice of the majority of clinicians.

ENC training reduces perinatal mortality in Karnataka, India

Objective: To evaluate the effect of World Health Organization Essential Newborn Care course and the American Academy of Pediatrics Neonatal Resuscitation Program training on perinatal mortality in rural India. Methods: This study was part of a multi-country prospective, community-based cluster randomized controlled trial. Birth, 7-day and 28-day neonatal outcomes for all women with pregnancies greater than 28 weeks in the 26 study communities in Karnataka, India were included. Mortality rates pre- and post-Essential Newborn Care training were collected prospectively and then communities randomized to either receive neonatal resuscitation or refresher newborn care training in the control clusters. Results: Consent was obtained on 99% of the 25,096 births. Perinatal mortality for infants ≥500 g decreased from 52 to 36/1000 after newborn care training (RR 0.7; 95% CI 0.5, 0.9); stillbirth decreased from 23 to 14/1000 (RR 0.62; 95% CI 0.46, 0.83) and early neonatal mortality decreased from 29 to 22/1000 (RR 0.74; 95% CI 0.53, 1.03). Mortality was not reduced further with resuscitation training. Conclusions: Using a pre–post design, World Health Organization Essential Newborn Care community birth attendant training resulted in a significant reduction in perinatal mortality. In low-resource settings, the newborn care training package appears to be an effective intervention to decrease perinatal mortality.

Is maternal asthma a life or death issue for the baby?

Asthma is probably the most common potentially serious medical problem to complicate pregnancy. In recent national surveys in the USA, 8.4–8.8% of pregnant women reported current asthma.1 Since 1970, many...

Neonatal and perinatal infant mortality rate in Bulgaria during the period 1997–2007

Neonatal and perinatal infant mortality rate in Bulgaria during the period 1997–2007

Analysis of the impact of early severe pre-eclampsia on outcome of gestation

Objective To investigate the effect of expectant management on the maternal and/or infant out-comes of early onset severe preeclamp sia in different gestafional weeks. Methods A retrospective study was carried out on 158 patients with early onset severe preeclampsia. They were divided into three groups according to their onset gestation ago:group A( <28weeks,n=28) ,group B(≥28、<32weeks,n=51) and group C(≥32、< 34weeks,n =79). Results The rates of complications declined along with the postponement of the onset gestation age, but there was no statistical significant difference among these three groups. The neonatal asphyxia rate and perinatal infant mor-tality of these three groups declined along with the postponement of gestation age, and there were statistical significant differences among these three groups ( P<0.05 ). Expectant treatment time of group B was significantly longer than that of the other two groups ( P<0.05 ), and cesarean section was a main method of pregnancy termination for the groups B and C. Conclusion The smaller the gestational ages in the early onset severe preeelampsia,the higher the maternal and/ or infant complication rates, neonatal morbidity and mortality. Key words: Pre-eclampsia; Asphyxia neonatorum; Infant mortality

A Comparison of Perinatal Mortality in Korea on Holidays and Working Days

The objective was to examine whether the perinatal mortality of infants born during holidays differs from that of infants born on workdays and to elucidate its cause. Design: Cross-sectional study. Setting: Vital statistics linked to the National Infant Mortality Survey data for 1999 births in Korea. Population: In all 628 485 births in 1999 in Korea. Methods: Number of births and perinatal mortality were classified according to the day of the week using the occurrence index. After adjusting for confounding factors the odds ratios (ORs) for increased holiday mortality were estimated using logistic regression. Main outcome measure: Birthweight-adjusted perinatal mortality. Births on holidays were 33% fewer and perinatal deaths 24% higher than expected (PMR Perinatal Mortality Rate 16.4 versus 12.8; OR 1.3; 95% CI 1.2-1.4). After the adjustment of birthweight gender plurality and congenital anomalies the odds ratio for death of infants born during holidays was 1.2 (95% CI 1.1-1.3). The higher perinatal mortality during holidays in Korea appears to be due to different qualities of perinatal care rather than difference in case-mix. (authors)

A comparison of perinatal mortality in Korea on holidays and working days

To examine whether the perinatal mortality of infants born during holidays differs from that of infants born on workdays, and to elucidate its cause. Cross-sectional study. Setting Vital statistics linked to the National Infant Mortality Survey data for 1999 births in Korea. In all, 628 485 births in 1999 in Korea. Number of births and perinatal mortality were classified according to the day of the week using the occurrence index. After adjusting for confounding factors, the odds ratios (ORs) for increased holiday mortality were estimated using logistic regression. Birthweight-adjusted perinatal mortality. Births on holidays were 33% fewer and perinatal deaths 24% higher than expected (PMR, Perinatal Mortality Rate, 16.4 versus 12.8; OR, 1.3; 95% CI, 1.2-1.4). After the adjustment of birthweight, gender, plurality and congenital anomalies, the odds ratio for death of infants born during holidays was 1.2 (95% CI, 1.1-1.3). The higher perinatal mortality during holidays in Korea appears to be due to different qualities of perinatal care, rather than difference in case-mix.

Infant Mortality Reviews in the Aberdeen Area of the Indian Health Service: Strategies and Outcomes

To determine cause and manner of death for consecutive infant deaths in the Aberdeen Area of the Indian Health Service (AAIHS) from 1998 to 2002 and to identify risk markers for infant mortality. Infant deaths in the AAIHS were identified from four data sources: death certificates from the four states in the AAIHS, deaths reported by local IHS Service Units, from obituaries in local and regional newspapers, and deaths reported by area hospitals. Each infant death is then sent to the local IHS service unit for review, where data from the infant and mother's chart is extracted and recorded. Local community factors, birth and death certificates, and autopsy reports are collected. The case is then reviewed at the Perinatal Infant Mortality Review (PIMR) meeting and a cause and manner of death is assigned. Summary data for the cohort was examined and then compared by mortality category and three age-at-death groups. Sudden infant death syndrome accounted for 33% of all infant deaths in the AAIHS. Prematurity was the second most prevalent cause-specific mortality category, accounting for 22% of all infant deaths. The authors found that infant mortality was surprisingly recurrent, with 32% of mothers of this infant having had a previous infant death. The PIMR committee requires substantial resources to support a review committee with appropriate expertise and their travel. Participation of local IHS staff and tribal members provides an important cultural and community perspective for the review process. Quality improvement changes are currently being implemented. These include increasing data on substance use, mental health needs, and reviews of fetal deaths. The process of mortality review has been very helpful in public education in the AAIHS.

CONGENITAL ANOMALIES AMONG INFANTS OF DIABETIC MOTHERS

SUMMARY Congenital anomalies are the most common cause of perinatal mortality in infants of diabetic mothers. Late fetal loss and metabolic abnormalities also feature in increased perinatal mortality due to maternal diabetes. Maternal hyperglycemia during early gestation is associated with an increased frequency of structural defects. Four infants who were admitted to the Neonatal Intensive Care Unit (NICU) of our institution are presented here in a discussion of rare congenital malformations in infants of diabetic mothers.

Effect of hypertensive pregnancy complications on neonatal outcome of growth retarded fetuses

To determine the effect of hypertensive disorders in pregnancy on the neonatal outcome of growth restricted fetuses. There is conflicting data on the effect of hypertension during pregnancy on the incidence of neonatal respiratory distress syndrome (RDS) and intraventricular hemorrhage. Some studies report a lower incidence of RDS and intraventricular hemorrhage in infants of hypertensive mothers, whereas other studies report a similar or higher incidence in infants born to hypertensive mothers. We performed a retrospective analysis of 220 growth restricted fetuses born between January 1, 1996 to July 1, 1997 at the Department of Obstetrics and Gynecology of the University-Hospital at Homburg/Saar. Data were obtained by review of the medical records. Growth restricted infants born to preeclamptic women or women with HELLP syndrome were compared to growth restricted fetuses born to mothers without hypertensive disorders. Growth restricted fetuses born to hypertensive mothers had a significant lower birth weight (p < 0.05). The incidence of RDS in children born to hypertensive mothers was significantly higher (p < 0.05, p < 0.01) and they stayed significantly longer in the neonatal intensive care unit (p < 0.01). In contrast to infants born to mothers with HELLP syndrome (n = 7) there was no difference in the incidence of intraventricular hemorrhage, infection, sepsis, necrotizing enterocolitis or cardiac complications (arrhythmia, insufficiency) in case of preeclampsia (n = 68). The perinatal mortality of infants born to hypertensive mothers was significantly higher (p < 0.05, p < 0.01). This study does not support the contention that hypertensive disorders in pregnancy have a beneficial effect on the postnatal course of IUGR infants.

Intensive care unit utilization during pregnancy

Objective: To characterize obstetric (OB) and nonobstetric (Non-OB) intensive care unit (ICU) admissions in relation to maternal and perinatal outcomes.Study design: We identified 172 (0.6%) women (15 weeks of gestation to 6 weeks postpartum) admitted to an ICU (medical, cardiovascular, neurosurgical, and surgical) within 30,405 deliveries at our institution from 1989 to 1997 (2,774 maternal-fetal transports, 6.3%). Obstetric and Non-OB admission outcomes were compared.Results: Of 172 patients, 116 (67%) were maternal transports (63 maternal-fetal, 53 maternal). Common OB conditions were hypertension (22, 12.6%), hemorrhage (17, 9.7%), and cardiopulmonary dysfunction (28, 16%). Non-OB conditions included pneumonia (26, 14.9%), trauma (16, 9.1%), and cerebrovascular accident (11, 6.2%).Conclusions: Maternal and neonatal outcomes were similar between OB and Non-OB ICU admissions. Maternal mortality was appreciable (13%); however, the perinatal mortality of infants delivered in the ICU was low (11%). Selected outcomesOB (N = 92)Non-OB (N = 83)MaternalICU, days (mean ± SD)6.2 ± 11.013.3 ± 32.7Mechanical ventilation (N, %)55 (60)48 (58)Dialysis (N, %)5 (0.5)4 (0.5)Transfusion (N, %)62 (67)48 (58)Maternal death (N, %)12 (13)11 (13)PerinatalICU antepartum (N, %)13 (14)42 (53)Fetus alive (N)1336Admit GA (mean ± SD)26.7 ± 7.026.2 ± 5.9ICU delivery (N)5/1313/36Fetal mortality (N)11Neonatal mortality (N)00Discharged undelivered (N)823