Perinatal Mortality Research Articles

The Effectiveness, Safety and Outcome of Low Dose Aspirin for The Prevention of Superimposed Preeclampsia in Women with Chronic Hypertension : A Comprehensive Systematic Review

Background: Low-dose aspirin therapy has been shown to reduce pregnancy-related complications, including pre-eclampsia, in pregnant women with chronic hypertension. However, mixed findings suggest that it does not significantly alter the likelihood of developing superimposed pre-eclampsia, preterm birth, or perinatal mortality in women with chronic hypertension. Methods: This systematic review complied with the PRISMA 2020 requirements, concentrating solely on full-text papers published in English from 2014 to 2024. Editorials and review articles lacking a DOI were omitted to guarantee the use of high-quality sources. A comprehensive literature review was performed using esteemed databases such as ScienceDirect, PubMed, and SagePub to locate pertinent studies. Result: The initial database search identified over 200 publications relevant to the topic. Following a meticulous three-stage screening process, eight studies were selected that met the predefined inclusion criteria for comprehensive analysis. These studies were subjected to a rigorous critical evaluation, providing an in-depth investigation into the effectiveness, safety, and outcomes of low-dose aspirin for the prevention of superimposed pre-eclampsia. This focused approach ensured that the analysis drew from high-quality evidence directly aligned with the study's objectives. Conclusion: Superimposed preeclampsia, a condition causing preterm birth and neonatal intensive care unit admissions, is a risk for chronic hypertension women. Aspirin, a low-dose medication, has shown mixed efficacy in preventing this condition, with dose-dependent effectiveness.

Exploring machine learning algorithms to predict not using modern family planning methods among reproductive age women in East Africa

BackgroundThe use of the modern family planning method provides chances for women to reach optimal child spacing, increase quality of life, increase economic status, achieve the desired family size, and prevent unsafe abortions and maternal and perinatal deaths. However, use modern family planning is low among reproductive age women in East Africa. Therefore, this study aimed at predicting not using modern family planning and identifying its associated factors among reproductive age women in east Africa using machine learning methods.MethodsThe data set was obtained from a demographic health survey in East Africa. This study used data on weighted sample of 92,564 women who were in their reproductive age. Python software was utilized for data processing, and machine learning models such as Random Forest (RF), Decision Tree (DT), XGB (Extreme Gradient Boosting), SVM (Support Victor Machine), and K-Nearest Neighbor Decision Tree (DT) were implemented. In this work, we evaluated the predictive models’ performance using performance assessment criteria such as accuracy, precision, recall, and the AUC curve.ResultIn this study, 92,564 reproductive women’s was used in the final analysis. Among the proposed machine learning models, XGB performed best overall in the proposed classifier, with an accuracy of 98.7%, precision of 99.8%, recall of 98%, 99.9% AUC score, had high specificity 98%, sensitivity 99.8%, and low error rate discovery was 0.013%. The most significant determinants of not using modern family planning in East Africa: lack of education, age 25–29, living in a rural area, being single, not knowing how to use a contraceptive, and smoking cigarette.ConclusionExtreme Gradient Boosting proved effective in predicting not using modern family planning, offering valuable insights for interventions and policy decisions in East Africa. Machine learning could help achieve early prediction and intervention on reproductive women’s not using modern family planning. This leads to a recommendation for policy direction to reduce child and maternal mortality and improve living standards in east Africa.

Determinants of neonatal mortality among hospitalised neonates with sepsis at Queen Elizabeth Central Hospital, Blantyre, Malawi: A mixed-methods study.

Neonatal sepsis-related deaths remain a significant health problem contributing to higher morbidity and mortality rates, particularly in low resource settings, such as Malawi. However, there is limited information to associate risk factors and health system factors with mortality. This study investigated the risk factors associated with mortality and explored health system factors contributing to deaths among neonates with sepsis at Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi. This mixed-method study utilised a convergent parallel approach to describe the determinants of neonatal mortality among neonates with sepsis. We selected this design because it allowed the researchers to triangulate, support and enhance the internal and external validity of the results. We retrospectively reviewed 237 neonatal records using a simple random sampling technique for cross-sectional quantitative data. Exploratory qualitative data was collected using a semi-structured interview guide from 10 purposively selected healthcare workers directly involved in providing neonatal care through in-depth interviews. Quantitative data were analysed using univariate and multivariate logistic regression in Stata v.14; qualitative data were analysed manually using a thematic analysis approach. We found that gestation age (OR 0.76 (95% CI: 0.58, 0.99), p-value = 0.040) and number of days spent in the hospital (OR 0.64 (95% CI: 0.48, 0.85), p-value = 0.002) were the most predictive risk factors. The qualitative inquiry showed the maternal behavioural factors; reporting late to hospital, cultural and religious beliefs; maternal health related factors: prolonged labour, unnecessary vaginal examinations, premature rupturing of membranes; Neonatal factors: prematurity, meconium aspiration, home deliveries and lastly, health system factors included delay in treatment, referrals and blood culture results, limited resources contributed to documented clinical outcomes. Determinants of neonatal mortality were gestation age, number of days spent in the hospital, maternal behavioural and health related, neonatal and health system factors. Reducing mortality among neonates with sepsis will require a multi-sectoral approach.

The Use of Novel Therapies in the Management of Haemolytic Disease of the Fetus and Newborn (HDFN): Scientific Impact Paper No. 75.

Haemolytic disease of the fetus and newborn (HDFN) is a rare condition that causes a baby to develop anaemia while growing inside the woman; or after birth. Left untreated, this may lead to stillbirth or neonatal death. HDFN is caused when the pregnant woman's antibodies cross the placenta, enter the baby's circulation, and attach to proteins called antigens (inherited from the father) on the baby's haemoglobin containing red blood cells, and cause them to break apart, causing fetal anaemia. Women routinely have their blood tested at the start of pregnancy to assess their ABO blood group and Rh antigens. There are five main Rhesus antigens: D, C, c, E, e; with anti-D being responsible for most cases of HDFN. If a woman is found to be Rh D negative; a 'non-invasive' blood test is performed to assess if the fetal blood group is the same as the woman's. If a woman is found to be Rh D negative, and the baby is found to be D positive, the baby is at risk. This is because the baby has inherited the D antigen from the father; so-called Rhesus incompatibility. Other red blood cell antibodies such as anti-Kell or anti-Duffy can also cause fetal anaemia. Women at highest risk of developing HDFN are those who have had at least one previous birth or a sensitising event (such as abdominal trauma) in a current or previous pregnancy, causing the woman and baby's blood to mix. Current treatment for haemolytic disease of the fetus involves giving fetal blood transfusions, with a small risk of early labour or pregnancy loss. If anaemia develops later in pregnancy, early delivery of the baby may be recommended; which could lead to complications of prematurity. In cases of mild HDFN, the baby may only require light therapy for neonatal jaundice. However, if the anaemia occurs earlier in pregnancy and is severe, the baby may need blood transfusions while still in the womb - and after birth may require an exchange transfusion, to remove the woman's antibodies from their circulation and to treat the anaemia. Intravenous immunoglobulin (IVIG) is a potential non-invasive method to prevent or delay the onset of severe anaemia. It is a blood product given intravenously every week to women who have been deemed at very high risk of early onset HDFN. It can be started at the end of the first trimester until birth, or until anaemia develops. This paper will discuss the evidence behind IVIG and other novel therapies during pregnancy, including the risks and the benefits. The developers of the paper include obstetricians, neonatologists and haematologists to provide different opinions on this topic.

Predictors of neonatal mortality among neonates in Tigray regional state, Ethiopia: A cross-sectional study.

Since 2015, Ethiopia is committed to lowering the death rate for children under five and it is one of the countries in Sub-Saharan Africa that has accomplished the fourth Millennium Development Goal. However, in Ethiopia, neonatal death has remained a serious public health concern, with greater rates found in Tigray regional state and the predictors aren't well recognized. The goal of this study was to ascertain the prevalence of neonatal death in the Tigray regional State as well as any relevant risk factors. This study performed a secondary data analysis of the 2016 Ethiopia Demographic and Health Survey (EDHS) report. Information was gathered on 716 neonates who were born five years before the survey began. Risk factors for neonatal mortality were thought to include mother and neonate demographics, health, and environmental factors. The study employed multivariable logistic regression model analysis and descriptive statistics to identify significant correlates of neonatal mortality. In Tigray regional state, the overall prevalence of neonatal mortality was 4.3% (95% CI: 3.06, 6.10). The multivariable logistic regression model analysis revealed that factors such as multiple birth types (AOR = 15.3, 95% CI: 3.54, 65.84), birth order (2-4) (AOR = 4.88, 95% CI: 1.52, 15.7), sex of the neonate (being male) (AOR = 3.75, 95% CI: 1.45, 9.75), home place of delivery (AOR = 7.4, 95% CI: 2.0, 27.6), and neonates born to mothers aged 20-34 years (AOR = 0.23, 95% CI: 0.087, 0.58) were significantly risk factors associated with a higher risk of neonatal mortality rate. The study recognized the sex of the neonate, birth order, mother's age, place of delivery, and birth type as potential risk factors for neonatal mortality. The prevalence of neonatal mortality indicated that the neonatal mortality rate in Tigray regional state was higher than the national average. To reduce neonatal mortality, targeted interventions should focus on high-risk groups, such as mothers delivering at home and those with multiple births.

Neonatal septicemia: Diagnostic challenges and the role of CRP and blood culture

Neonatal septicemia, a serious blood infection occurring within the first four weeks of life, is a significant cause of neonatal deaths. Its diagnosis is challenging due to the non-specific nature of its signs and symptoms. C-reactive protein (CRP) serves as a valuable biomarker for early detection, facilitating timely treatment and improving survival rates as a rapid adjunct to the standard blood culture process. This study explores the relationship between CRP levels and blood culture findings in diagnosing Neonatal septicemia. The objectives were to determine common organisms causing neonatal septicemia, to evaluate CRP as a diagnostic tool for Neonatal septicemia compared to blood culture results. The study examined the correlation between CRP levels and blood culture outcomes in neonates suspected of having sepsis. Blood samples were aseptically collected and inoculated in 1 set of BD BACTECTM Peds Plus/F blood culture bottles, incubated for five days using a BD BACTEC automated machine. The bacteria isolated from positive blood culture were processed using Vitek-2. CRP levels were determined using the latex agglutination card test, with positive samples further analyzed via quantitative nephelometry. Of the 321 samples, 28.97% (93) tested positive for bacterial sepsis via blood culture. Among these, 33.3% (31 cases) were , 18.3% (17 cases) were , and 11.8% (11 cases) were , with coagulase-negative staphylococci (CONS) being the most common group overall. Among the Gram-negative organisms, (8.6%) and (6.5%) were significant contributors to neonatal septicemia. CRP was positive in 82 cases with blood culture-positive samples and in 105 cases with blood culture-negative samples, underscoring its potential as a diagnostic marker for Neonatal septicemia. While CRP is a valuable biomarker for detection of Neonatal septicemia, it should not be used as a sole diagnostic tool due to its lack of specificity. CRP testing provides a presumptive diagnosis that can guide early antibiotic therapy, emphasizing its significance in neonatal care.

Amplitude-integrated electroencephalography showed alterations in cerebral activity in monochorionic twins with twin-to-twin transfusion syndrome.

Monochorionic twins are at higher risk of perinatal mortality and morbidity, primarily due to pregnancy-related complications, such as twin-to-twin transfusion syndrome (TTTS). We aimed to investigate whether amplitude-integrated electroencephalography (aEEG) signals are different between monochorionic twins with and without TTTS. This was a retrospective single-centre study conducted at Innsbruck Medical University Hospital, Austria. Preterm infants born before 32 weeks of gestation between 6 November 2010 and 6 December 2022 were eligible. The aEEG was analysed for the total maturation score, its component scores and the number of sleep-wake cycles per hour. We enrolled 79 monochorionic twin infants (48% male) and 157 dichorionic (62% male) twin infants. We found no differences between these two groups of preterm infants regarding the total maturation and component scores, or the number of sleep wake cycles. Monochorionic twins with TTTS showed significantly lower total maturation scores and individual component scores compared to monochorionic twins without TTTS. Preterm infants with TTTS showed differences in neonatal aEEG signals. Whether these differences are caused by prematurity-related or TTTS-related factors, such as hemodynamic and metabolic changes due to placental anastomoses, should be investigated in future prospective studies, to gain more insight into this important topic.

Midwives' perspectives on rural birthing experiences and newborn survival in Ghana

BackgroundAccess to essential and emergency newborn care services remains a challenge in low- and middle-income countries (LMICs), especially in rural and remote areas where various factors increase maternal and newborn vulnerability. The scarcity of midwives on a global scale further strains obstetric and neonatal services, as midwives work at the forefront in many LMICs. In Ghana, neonatal deaths at birth and within 24 h contribute significantly to infant mortality rate, with midwives caring as frontline health workers. However, there is limited exploration of midwives' experiences in managing these situations. This study aimed to unveil the meanings and articulate the experiences of midwives who face newborns with respiratory distress at birth in rural southern Ghana.MethodsInterpretive Phenomenological approach was used to explore thirteen (13) midwives’ experiences of managing newborns in respiratory distress in rural birth settings amidst scare life saving resources, skilled staff shortage and limited advanced health care. The midwives were purposively sampled from the Shai-Osudoku district and data were collected through face-to-face interviews. Content analysis was conducted on the interview transcripts and rich narratives developed in the research report.ResultsRural midwives have limited access to newborn lifesaving equipment, adequate training, skill staff support, and timely advance care for newborns. These issues are driving factors for newborn referral in rural health care, but transportation gaps impede timely advance care delivery. Rural midwives’ inadequate psychosocial support and lack of enabling work environment engender moral distress with emotional burden requiring sustained attention from national leadership, as well as midwifery professional networks and regulatory bodies.ConclusionNewly qualified midwives require sustainable support as they struggle in birth spaces where ethical questions emerge as family members are engaged as support persons in neonatal resuscitation. Future research is needed to investigate Chiefs, Queen Mothers and Community Elders’ engagement in community-based interventions to support timely access to quality care and midwives’ heroic practices of saving maternal/newborn lives in rural Ghana to help achieve SDG 3.2.

Persistent Racial Disparities in US Infant Mortality, 1995-2017

In the United States, black babies are significantly more likely to die at birth than white babies. In order to determine the relationship between the risk of neonatal death and race, this research conduct a national-based study of 89.7 million live singleton births between 1995 and 2017. We assessed whether the racial/ethnic disparity in infant mortality narrowed, persisted, or widened over these years, which coincides with a period of substantial improvements in neonatal care. Our study contributes to a growing literature on racial disparities in infant mortality.

Perinatal lamb survival was not reduced by grazing forage oats

Context Grazing forage oats (Avena sativa) is perceived as a risk to perinatal lamb survival and grazing oats only during the lambing period has reduced lamb survival. Aims This study assessed whether perinatal lamb mortality differed for ewes grazing a legume-based pasture throughout the lambing period compared with those grazing oat forage during lambing. Methods A randomised design used two replicates each of two litter sizes (singles or twins) in two forage treatments. Mature Merino ewes were used (n = 424; 53 per group) and all groups grazed legume-based pasture from 6 weeks prior to the start of the lambing period. Control ewes remained on legume pastures, whereas Oat groups were moved to forage oats 9–11 days before lambing. A calcium, magnesium and sodium loose lick supplement was offered to all groups. Key results Ewe mortality was 1.2%, mainly in twin-bearing ewes and similar among treatments. Lamb birthweights were similar; however liveweight at marking was greater for lambs that were born on the legume pastures than for those born on the oats (13.1 ± 0.19 and 12.5 ± 0.18 kg; P = 0.041). Lamb survival did not differ (P = 0.192) between ewes grazing oats (87.3 ± 3.4%) and those grazing legume pasture (78.1 ± 3.4%), and resulted in 1.28 versus 1.14 (P = 0.143) lambs marked/ewe. Lamb survival was similar (P = 0.102) for singles (89.2 ± 3.2%) and twin lambs (76.2 ± 3.2%). Loss in condition score during the lambing period was reduced (P < 0.001) by grazing oats (−0.2 ± 0.06) compared with legume pasture (−0.6 ± 0.06). Conclusions Lamb survival was not reduced by grazing oats rather than legume pasture during the lambing period, although further replication is needed, given the large numerical difference. Any difference in survival between oats and a legume-based pasture when ewes are offered a calcium, magnesium and sodium supplement may depend on the capacity of forage to meet the energy requirements of ewes, although taller oats potentially provide shelter from wind chill. Implications Grazing forage oats during the lambing period has variable effects on lamb survival associated with the relative ability of alternative pasture to provide adequate nutrition, with positive impacts possible.

The Italian Perinatal Surveillance System SPItOSS: insights from Confidential Enquiries

BackgroundAn effective strategy to reduce perinatal mortality requires an active surveillance system. This includes monitoring cases, organizing multidisciplinary local audits, conducting Confidential Enquiries, identifying avoidable factors, and facilitating changes in the healthcare system. In 2017, the Italian Obstetric Surveillance System launched the SPItOSS pilot Perinatal Surveillance System. The aim of this paper is to describe the results of the SPItOSS Confidential Enquiries on perinatal deaths focusing on the emergent critical aspects in obstetric and neonatal care, as well as on the healthcare facilities organization.MethodsSPItOSS, a population-based surveillance system, collected and analysed incident perinatal deaths from July 2017 to June 2019 in three Regions encompassing 32.3% of Italian births. Cases were defined according to WHO definition as fetuses born dead ≥ 28 weeks of gestation and live newborn died within 7 days from birth. The International Statistical Classification of Diseases and related Health Problem-Perinatal Mortality was adopted for coding causes of death and contributing maternal and placenta-related conditions. Confidential Enquiries, prioritized according to perinatal deaths preventability, were conducted by expert committees at Regional and National level.ResultsA total of 830 incident perinatal deaths were notified, with 58.3% classified as antepartum, 4.3% as intrapartum, and 37.3% as neonatal deaths. According to the SPItOSS protocol, Confidential Enquiries evaluated only the most preventable deaths, including 19 intrapartum and 70 neonatal deaths. Of these, 43.8% were assessed as unavoidable with appropriate care; 29.2% as unavoidable with improvable care, and 15.7% as avoidable due to inappropriate care. Most intrapartum deaths were attributed to intrauterine hypoxia, while neonatal deaths recognized a multifactorial aetiology. Different aspects of inappropriate care were highlighted, such as failure to recognise maternal or fetal problems before labour, delayed or inappropriate neonatal resuscitation, and poor or suboptimal neonatal monitoring.ConclusionsThe SPItOSS Confidential Enquires provided insights for improving maternity and perinatal services. By targeting key areas of obstetric and neonatal care, the surveillance can generate recommendations and actions to prevent avoidable perinatal deaths.

Modern view of the causes of antenatal fetal death

About two million cases of prenatal fetal death are recorded annually, that is, a stillborn baby is born every 16 seconds. However, even such impressive data does not reflect the full scale of the problem. The WHO data does not include stillbirth rates at 22–28 weeks, which some studies estimate would increase the rate by about 40%. The difference in stillbirth rates in developed and developing countries indicates the quality of medical care and, as a result, the country’s medical system. According to the Federal State Statistics Service, the stillbirth rate in the Russian Federation accounts for a large share of perinatal loss (79%) and does not have a downward trend. Besides, there is currently no unified classification of the causes of prenatal fetal death, which complicates the analysis of stillbirth cases and possible reserves for their reduction. It is noteworthy that the proportion of cases with an unknown cause of perinatal mortality is growing (3.1% in 2019 and 4.7% in 2020). Despite the fact that the rate of unexplained causes of antenatal fetal death in the Russian Federation is almost three times lower than abroad, the large proportion of causes associated with fetal asphyxia deprives these data of specificity. Against the backdrop of the demographic crisis in the Russian Federation (the birth rate for 2022 was 1.4), identifying risk factors for antenatal fetal death is especially acute, since this underlies the creation of preventive measures to reduce the risk of adverse obstetric outcomes.

Prenatal-Postnatal Outcomes and Prognostic Risk Factors of Fetal Volvulus: Analysis of 26 Cases.

The aim of the current study was to reveal ultrasonographic and clinical features, prenatal-postnatal outcomes and prognostic risk factors of fetal volvulus. This retrospective study evaluated all cases of fetal volvulus diagnosed between 2018 and 2024 at the Perinatology center of Zeynep Kamil Women and Children Diseases Training and Research Hospital. In the vast majority of cases, the pediatric surgery team confirmed the conclusive diagnosis of volvulus during the postnatal period. The cohort was divided into two groups, the "survivor" and "deceased", in order to compare the outcome and to evaluate factors determining the outcome. A total of 26 cases of fetal volvulus were followed up in our perinatology center which were confirmed by postnatal pediatric surgery or autopsy. Termination of pregnancy in two cases and intrauterine fetal death in one case were observed. Twenty-three cases reached live birth. Preterm labor, fetal growth restriction, ascites and decreased intestinal peristalsis were significantly more common in the deceased group. Neonatal death in five cases (19.2%), infant death in four cases (15.3%) and short gut syndrome in three cases (11.5%) were long term outcomes. Overall mortality rate may increase when fetal growth restriction, ascites, and decreased intestinal peristalsis are present with volvulus.

Abnormal microRNA expression profile at early stages of gestation in pregnancies destined to develop placenta previa.

Placenta previa is the abnormal implantation of the placenta into the lower segment of the uterus, is associated with adverse maternal and fetal outcomes such as placenta accreta spectrum disorders, antepartum and postpartum hemorrhage, fetal growth restriction, prematurity, stillbirth and neonatal death, thrombophlebitis, and septicemia. The aim of the study was to assess retrospectively how the later onset of placenta previa affects the microRNA expression profile in the whole peripheral blood during the first trimester of gestation. Regarding the occurrence of the association between aberrant microRNA expression profiles at early stages of gestation and later onset of various pregnancy-related complications, we selected for the study pregnancies developing placenta previa as the only pregnancy-related disorder. In total, 24 singleton pregnancies diagnosed with placenta previa that underwent first-trimester prenatal screening and delivered on-site within the period November 2012-May 2018 were included in the study. Overall, 80 normal pregnancies that delivered appropriate-for-gestational age newborns after completing 37 weeks of gestation were selected as the control group based on the equality of the length of biological sample storage. Downregulation of multiple microRNAs (miR-20b-5p, miR-24-3p, miR-26a-5p, miR-92a-3p, miR-103a-3p, miR-130b-3p, miR-133a-3p, miR-145-5p, miR-146a-5p, miR-155-5p, miR-181a-5p, miR-195-5p, miR-210-3p, miR-342-3p, and miR-574-3p) was observed in pregnancies destined to develop placenta previa. The combination of seven microRNAs (miR-130b-3p, miR-145-5p, miR-155-5p, miR-181a-5p, miR-210-3p, miR-342-3p, and miR-574-3p) showed the highest accuracy (AUC 0.937, p < 0.001, 100.0% sensitivity, 83.75% specificity) to differentiate, at early stages of gestation, between pregnancies with a normal course of gestation and those with placenta previa diagnosed in the second half of pregnancy. Overall, 75% of pregnancies destined to develop placenta previa were correctly identified at 10.0% FPR. Consecutive large-scale analyses must be performed to verify the reliability of the proposed novel early predictive model for placenta previa occurring as the only pregnancy-related disorder.

Predictors of Death or Severe Impairment in Neonates With Hypoxic-Ischemic Encephalopathy

Outcomes after hypoxic-ischemic encephalopathy (HIE) are variable. Predicting death or severe neurodevelopmental impairment (NDI) in affected neonates is crucial for guiding management and parent communication. To predict death or severe NDI in neonates who receive hypothermia for HIE. This prognostic study included participants enrolled in a large US clinical trial conducted in US neonatal intensive care units who were born between January 2017 and October 2019 and followed up to age 2 years. Eligible participants were neonates with moderate-severe HIE born at 36 weeks or more gestation and with 2-year outcome data. Data were analyzed June 2023. External validation was performed with a UK cohort. Clinical, electroencephalography (EEG), and magnetic resonance imaging (MRI) variables were curated and examined at 24 hours and following cooling. Death or severe NDI at age 2 years. Severe NDI was defined as Bayley Scales of Infant Toddler Development cognitive score below 70, Gross Motor Function Classification System score of 3 or higher, or quadriparesis. Model performance metrics were derived from training, internal, and external validation datasets. Among 424 neonates (mean [SD] gestational age, 39.1 [1.4] weeks; 192 female [45.3%]; 28 Asian [6.6%], 50 Black [11.8%], 311 White [73.3%]), 105 (24.7%) had severe encephalopathy at enrollment. Overall, 59 (13.9%) died and 46 (10.8%) had severe NDI. In the 24-hour model, the combined presence of 3 clinical characteristics-(1) severely abnormal EEG, (2) pH level of 7.11 or below, and (3) 5-minute Apgar score of 0-had a specificity of 99.6% (95% CI, 97.5%-100%) and a positive predictive value (PPV) of 95.2% (95% CI, 73.2%-99.3%). Validation model metrics were 97.9% (95% CI, 92.7%-99.8%) for internal specificity, with a PPV of 77.8% (95% CI, 43.4%-94.1%), and 97.6% (95% CI, 95.1%-99.0%) for external specificity, with a PPV of 46.2% (95% CI, 23.3%-70.8%). In the postcooling model, specificity for T1, T2, or diffusion-weighted imaging (DWI) abnormality in at least 2 of 3 deep gray regions (ie, thalamus, caudate, putamen and/or globus pallidus) plus a severely abnormal EEG within the first 24 hours was 99.1% (95% CI, 96.8%-99.9%), with a PPV of 91.7% (95% CI, 72.8%-97.8%). Internal specificity in this model was 98.9% (95% CI, 94.1%-100%), with a PPV of 92.9% (95% CI, 64.2%-99.0%); external specificity was 98.6% (95% CI, 96.5%-99.6%), with a PPV of 83.3% (95% CI, 64.1%-93.4%). In this prognostic study of neonates with moderate or severe HIE who were treated with therapeutic hypothermia, simple models using readily available clinical, EEG, and MRI results during the hospital admission had high specificity and PPV for death or severe NDI at age 2 years.

Association between maternal physiological and pathological factors and the risk of stillbirth and perinatal mortality

Association between maternal physiological and pathological factors and the risk of stillbirth and perinatal mortality

Hemolytic disease of the fetus and newborn: pregnant person's and fetal immune systems interaction.

There exists a need to research new diagnostic and therapeutic approaches that consider hemolytic disease of fetus and newborn (HDFN)'s physiopathology and focus not only on the pregnant person's immune system but also on the fetal immune system. This implies, in the final sense, to view the fetus as our patient. In spite of having found a safe and efficient method of prevention of HDFN more than 50 years ago, HDFN continues to be a relevant cause of perinatal morbidity and mortality, due to lack of access to immunoprophylaxis. In light of the above, we should strive to prevent sensitization and HDFN by ensuring certain health policies across the globe, especially in countries and regions of high morbidity and mortality.

Mathematical modelling to estimate the impact of maternal and perinatal healthcare services and interventions on health in sub-Saharan Africa: A scoping review.

Mathematical modelling is a commonly utilised tool to predict the impact of policy on health outcomes globally. Given the persistently high levels of maternal and perinatal morbidity and mortality in sub-Saharan Africa, mathematical modelling is a potentially valuable tool to guide strategic planning for health and improve outcomes. The aim of this scoping review was to explore the characteristics of mathematical models and modelling studies evaluating the impact of maternal and/or perinatal healthcare interventions or services on health-related outcomes in the region. A search across three databases was conducted on 2nd November 2023 which returned 8660 potentially relevant studies, from which 60 were included in the final review. Characteristics of these studies, the interventions which were evaluated, the models utilised, and the analyses conducted were extracted and summarised. Findings suggest that the popularity of modelling within this field is increasing over time with most studies published after 2015 and that population-based, deterministic, linear models were most frequently utilised, with the Lives Saved Tool being applied in over half of the reviewed studies (n = 34, 57%). Much less frequently (n = 6) models utilising system-thinking approaches, such as individual-based modelling or systems dynamics modelling, were developed and applied. Models were most applied to estimate the impact of interventions or services on maternal mortality (n = 34, 57%) or neonatal mortality outcomes (n = 39, 65%) with maternal morbidity (n = 4, 7%) and neonatal morbidity (n = 6, 10%) outcomes and stillbirth reported on much less often (n = 14, 23%). Going forward, given that healthcare delivery systems have long been identified as complex adaptive systems, modellers may consider the advantages of applying systems-thinking approaches to evaluate the impact of maternal and perinatal health policy. Such approaches allow for a more realistic and explicit representation of the systems- and individual- level factors which impact the effectiveness of interventions delivered within health systems.

Planned Home Births in the United States Have Outcomes Comparable to Planned Birth Center Births for Low-Risk Birthing Individuals.

There are lingering concerns in the United States about home birth. We used 2 large (n = 50,043; n = 62,984), national community birth registries to compare maternal and neonatal outcomes for planned home versus planned birth center births. To compare outcomes by intended birth site, we used logistic regressions, controlling for demographic and pregnancy risk variables. Maternal outcomes included intrapartum or postpartum transfer to hospital, hospitalization, cesarean, and hemorrhage; neonatal outcomes included neonatal transfer, hospitalization, neonatal intensive care unit admission, and intrapartum or neonatal death. Analyses were conducted twice, once in each dataset. Individuals who planned home births had a lower incidence of all types of transfers, compared with those who planned birth center births, but in one dataset only, experienced more cesareans [adjusted odds ratio (95% CI): 1.32 (1.02-1.70); 0.95 (0.88-1.03)]. Planned home birth was associated with lower adjusted odds of maternal hospitalization in one dataset but not the other [0.97 (0.54-1.74); 0.85 (0.76-0.95)], and was not associated with hemorrhage. Neonatal outcomes likewise were either not associated with a planned birthplace or suggested home birth was safer: hospitalization [0.77 (0.53-1.11), 0.90 (0.82-0.98)], neonatal intensive care unit admission [0.54 (0.28-1.00), 0.97 (0.86-1.10)]. There was no observable association with intrapartum or neonatal death: 1.07 (0.68-1.67; only calculated once because of small numbers of events). Planned home births are as safe as planned birth center births for low-risk pregnancies. Current guidelines advising against planned home births are not supported by these data.

OPtimal TIming of antenatal COrticosteroid administration in pregnancies complicated by early-onset fetal growth REstriction: results of a large, multicenter cohort study (the OPTICORE study).

Early-onset fetal growth restriction as consequence of placental insufficiency frequently requires iatrogenic, preterm birth. Administration of antenatal corticosteroids reduces risks of neonatal morbidity and mortality following preterm birth and is most beneficial if the neonate is delivered within two weeks following treatment. International guidelines on fetal growth restriction pregnancies do not provide directives regarding the timing of antenatal corticosteroids, resulting in practice variation. (s): This study compared the two main timing strategies of antenatal corticosteroids administration in the Netherlands for early-onset fetal growth restriction pregnancies: administration when the umbilical artery shows a pulsatility index above the 95th centile with (A) positive end-diastolic flow versus (B) absent or reversed end-diastolic velocity. A multicenter, retrospective cohort study was performed in six tertiary hospitals in the Netherlands between 2012-2021. Three hospitals practiced timing strategy A and three strategy B. The primary outcome was defined as a composite of perinatal and in-hospital mortality. Secondary outcomes were in line with the core outcome set for fetal growth restriction (COSGROVE). Mixed effects analyses were performed adjusted for birthweight z-score and gestational age at birth to compare the two timing strategies. A total of 1,453 patients were included, of whom 871 and 582 were treated according to timing strategy A and B, respectively. Corticosteroids were administered at a mean gestational age of 28 weeks and 3 days (standard deviation 16.0 days) in timing strategy A and 28 weeks and 4 days (standard deviation 15.8 days) in timing strategy B. The median birthweights were 1050 (range 795, 1350) and 1060 (range 801, 1339) in timing strategy A and B, respectively. Although not statistically significant, rates of perinatal and in-hospital mortality were increased in timing strategy B infants (7.2% versus 9.8%; adjusted odds ratio 1.47; 95% confidence interval 0.97-2.22, reference A). 52.8% and 53.6% of patients in strategy A and B, respectively, delivered within the corticosteroids therapeutic window of 2 to 14 days (P-value 0.663), with a median time between corticosteroid administration and delivery of 6 days for strategy A and 6 days for strategy B. Timing strategy B was associated with more necrotizing enterocolitis (3.7% versus 7.6%; adjusted odds ratio 2.18; 95% confidence interval 1.29-3.69), but less respiratory distress syndrome (39.6% versus 34.5%; adjusted odds ratio 0.63; 95% confidence interval 0.45-0.88) and bronchopulmonary dysplasia (18.9% versus 17.4%; adjusted odds ratio 0.69; 95% confidence interval 0.50-0.96). Other outcomes were similar between groups. Timing strategy B seemed to be associated with higher rates of the composite of perinatal and in-hospital mortality, which could not be explained by a difference in time intervals between corticosteroid administration and delivery. Importantly, most pregnant women delivered outside the presumed therapeutic corticosteroid window. Future research should focus on the improvement of the timing of antenatal corticosteroids in pregnancies complicated by early-onset fetal growth restriction and the identification of other differences in ante- and/or postnatal management to explain differences in outcomes, given the high risk for neonatal morbidity and mortality in this setting.