Perinatal Mortality Research Articles

Constrained optimization: evaluating possible packages of community health interventions with competing resource requirements in Galmudug, Somalia.

Investment in Community Health Worker (CHW) programs has allowed health systems to reach previously underserved rural and remote populations. As a result, CHWs are often burdened with responsibilities to deliver large packages of services, at times without sufficient human, financial, or health resources. To design a community-level program that saves maternal and newborn lives while operating within resource limitations, we used constrained optimization (a mathematical process for finding the solution to a stated objective while accounting for listed requirements) to construct a model for select villages in Galmudug State, Somalia. After establishing the resource requirements for delivering 25 evidence-based maternal and neonatal interventions, we used the Lives Saved Tool (LiST) and optimization techniques to determine the package of care that leads to the most projected lives saved. With a cadre of 1,450 Female Health Workers and a budget of $435,000 for maternal and neonatal health commodities and programming over one year, we calculated that the optimized set of interventions for Galmudug could avert 15% of the 4,132 projected maternal and neonatal deaths in 2024. We also conducted sensitivity analyses to show how the optimal combination of interventions and the number of lives saved change as the resource levels change. The model provides practitioners with a new tool and accompanying approach to evaluate possible packages of community health interventions with competing resource requirements.

Congenital neoplasms in cattle: A literature review and multi-institutional case series.

Congenital neoplasms are rare and sporadic in cattle and can cause losses due to abortions and perinatal or neonatal deaths. The etiopathogenesis of congenital tumors in bovine fetuses and neonates is largely unknown, and their diagnosis is often challenging. Here we review the literature on congenital tumors in cattle and report 11 additional cases diagnosed at veterinary diagnostic laboratories in Argentina, Uruguay, the United States, and the United Kingdom, namely 4 congenital lymphomas, 3 mesotheliomas, 2 adenomatoid tumors, 1 lymphangioma, and 1 ovarian sex cord-stromal tumor in bovine fetuses and/or neonatal calves. Lymphomas, mesotheliomas, melanomas, and mast cell tumors were reported most commonly in the literature.

Analysis of the uterine rupture during pregnancy and delivery in a provincial maternal and children care hospital in China: 2013–2022

BackgroundUterine rupture is rare and life-threatening for both mothers and newborns. This study aimed to explore the clinical manifestation, site of rupture, obstetric risk factors, maternal and neonatal complications, and birth outcomes with mid-trimester and late-pregnancy uterine rupture.MethodsData from patients with uterine rupture occurring at Hunan Maternal and Child Health Hospital between January 2013 and December 2022 were reviewed retrospectively.Results153,722 deliveries occurred during the 10 years of the study period. A total number of 129 uterine ruptures were identified: 12 ruptures occurred in the second trimester and 117 cases of uterine rupture diagnosed at or after 28 weeks gestation. The total incidence was 8.4/10,000. Most of the patients had a history of cesarean section (73.6%). 59.7% cases had a history of dilation and curettage. The rupture was more likely to occur on the lower uterine segment (86.82%). Seventy-one patients (55%) presented with abdominal pain or vaginal bleeding. Twenty-seven (20.9%) cases underwent a labor trial. There were 17 perinatal deaths associated with uterine rupture and neonatal asphyxia was observed in five infants. There was one maternal death. Postpartum hemorrhage occurred in 25 cases. Five patients underwent hysterectomy. Patients with uterine rupture during mid-trimester were more likely to receive a blood transfusion and exhibited higher rates of bladder injury.ConclusionUterine rupture especially mid-gestational uterine rupture is rare and remains a diagnostic challenge. Remarkably worse maternal outcomes were seen in patients with second-trimester rupture when compared with patients who experienced late-pregnancy rupture. Pregnant women with a history of uterine surgery, even at an early gestational age, should be closely monitored by obstetricians for the risk of uterine rupture if they experience persistent abdominal pain. Early recognition and prompt intervention are key to improve maternal and child outcomes.

The Effect of Chewing Chat During Pregnancy on Perinatal Outcome: Review

The consumption of khat during pregnancy is associated with an increased risk of low birth weight, congenital anomalies, premature rupture of membranes, perinatal mortality, and reduced APGAR scores at five minutes post-delivery. Furthermore, it is correlated with being small for gestational age at the time of delivery and a heightened incidence of fetal growth restriction (FGR).

Mode of delivery among preterm twins and offspring health, a retrospective cohort study

Although cesarean delivery (CD) has been linked to long-term health risks in singleton infants, the impact of delivery mode on long-term health outcomes in preterm twins remains underexplored. A retrospective cohort study was conducted at a tertiary medical center in Israel from 1991 to 2021, comparing preterm twins vaginally delivered (VD) versus cesarean section, excluding cases with congenital malformations or perinatal deaths. Kaplan–Meier survival curves were used to compare the cumulative incidence, and Cox proportional hazards models were applied to adjust for potential confounders. Four thousand twenty-eight preterm twin offspring were included, with 1703 (42%) VD and 2325 (58%) by CD. Preterm twins delivered by CD had a higher incidence of respiratory morbidities (42% vs. 35% in the VD group, p < 0.001), with an adjusted Hazard Ratio (aHR) of 1.15 (95%CI 1.02–1.30). CD was associated with an increased incidence of neurologic morbidities (22% vs. 17% in the VD group, p < 0.001), with an aHR of 1.16 (95%CI 1.02–1.36). CD was associated with a higher incidence of infectious morbidities (69% vs. 62%, p < 0.001), with an aHR of 1.10 (95%CI 1.01–1.21). Gastrointestinal morbidities were more pronounced in the CD group (29% vs. 25%, p < 0.001), but the multivariable analysis did not reach significance (aHR = 1.10, 95%CI 0.95–1.27). Sub-analyses of elective-uncomplicated deliveries showed consistent results for most morbidities. Conclusions: Cesarean delivery in preterm twins is associated with long-term respiratory, neurologic, infectious and gastrointestinal morbidities of the offspring. The findings suggest the potential benefits of vaginal over cesarean deliveries regarding offspring long-term health complications.What is Known:• Studies on singleton births show that cesarean delivery may increase respiratory, infectious, neurological and gastrointestinal outcomes remains inconsistent across term and preterm deliveries.• Cesarean delivery rates remain high despite recommendations to reduce their frequency, yet data on the association between cesarean delivery and morbidity among twins, particularly in small for gestational age twins, is limited.What is New:• This is the first large-scale study demonstrating that cesarean delivery in preterm twins increases the odds of respiratory, neurologic, infectious and gastrointestinal long-term morbidities up to age 18.• The higher rates of respiratory, neurologic, infectious, and gastrointestinal complications persist even in uncomplicated cesarean deliveries.

The Prevalence Of Peripherally Inserted Central Catheter Complications Among Neonate

Introduction Inserting a peripherally inserted central venous catheter (PICC) in neonatal intensive care units (NICUs) is becoming essential. Therefore, this study aimed to assess the prevalence and risk factors of PICC line-related complications. Methods A retrospective observational cross-sectional study was conducted in the Neonatal Intensive Care Unit between 2012 and 2019 at King Fahd Hospital of the University (KFHU), Khobar, Saudi Arabia. In total, 120 neonates were included in this study. Data on PICC line-related complications, including infection, thrombosis, occlusion, leakage, pericardial effusion, and neonatal death, were collected from medical records. Risk factors for PICC line-related complications were assessed using the chi-square test. Results PICC complications occurred in 28 (23.3%) of the 120 PICCs. The incidence of proven infection was (11.7%), leakage (10%), local infection (4.2%), and thrombosis (0.8%), and there were no deaths. The rate of complications was higher among neonates with low gestational age (24-26 weeks), extremely low birth weight, stay for 30 days or more, and older age (aged 10-14 days). Conclusion Findings from this study showed that one out of five neonates with PICC at the NICU experienced a PICC line-related complication, with infections and leakage being the most common complications. In the current study, PICC line-related complications were significantly associated with neonatal birth weight, gestational age, and length of stay.

First Trimester Ultrasound Biomarkers for Predicting Preeclampsia: A Prospective Cohort Study in Surabaya, Indonesia

Introduction: Preeclampsia (PE) remains a leading cause of maternal and perinatal morbidity and mortality worldwide, particularly in developing countries like Indonesia. Early identification of high-risk women is crucial for timely intervention. This study aimed to evaluate the predictive performance of first-trimester ultrasound biomarkers, specifically uterine artery pulsatility index (UtA-PI) and mean arterial pressure (MAP), combined with maternal characteristics, for predicting PE in a cohort of pregnant women in Surabaya, Indonesia. Methods: This prospective cohort study enrolled pregnant women attending their first-trimester antenatal care visit at Private Hospital, Surabaya, between January 2022 and December 2023. Inclusion criteria were singleton pregnancies, gestational age between 11 and 13 weeks 6 days, and availability of complete follow-up data until delivery. Maternal characteristics (age, body mass index, parity, smoking history, family history of PE) were recorded. UtA-PI was measured using transabdominal Doppler ultrasound, and MAP was calculated from blood pressure measurements. The primary outcome was the development of PE, defined according to the International Society for the Study of Hypertension in Pregnancy (ISSHP) criteria. Logistic regression analysis was used to develop a prediction model, and its performance was assessed using receiver operating characteristic (ROC) curves and area under the curve (AUC). Results: A total of 850 pregnant women were included in the final analysis. The incidence of PE was 8.2% (n=70). The prediction model incorporating maternal age, BMI, prior history of PE, UtA-PI, and MAP demonstrated good predictive performance for overall PE (AUC = 0.85; 95% CI, 0.81-0.89). For early-onset PE (delivery &lt;34 weeks), the AUC was 0.92 (95% CI, 0.87-0.97), and for late-onset PE (delivery ≥34 weeks), the AUC was 0.78 (95% CI, 0.73-0.83). UtA-PI and MAP were significant independent predictors of PE (p&lt;0.001). A risk score was developed, with a cut-off value showing a sensitivity of 80% and specificity of 75% for overall PE. Conclusion: The combination of maternal characteristics, UtA-PI, and MAP in the first trimester provides a valuable tool for predicting PE in an Indonesian population. This model demonstrates particularly strong performance for predicting early-onset PE, which is associated with greater maternal and fetal morbidity. Early identification of high-risk women allows for targeted surveillance and potential preventative strategies.

A systematic evaluation and comparison of the consistency of infant safer sleep messaging in Australia

To reduce the occurrence of sudden infant death, organisations have created recommendations about infant safer sleep and shared sleep. With the considerable volume of documents, consistency in messaging is paramount to reduce caregiver confusion and to reduce engagement in practices deemed to be unsafe for their infant. This review aimed to systematically compare documents that contain recommendations on infant safer sleep, including shared sleep, in Australia. Documents were identified by researchers with subject matter expertise, and through a systematic webpage search. A total of n = 32 eligible documents were included from n = 26 organisations. If an organisation had a separate document for shared sleeping, both documents were included and reviewed together. Consistency of recommendations were evaluated against the recommendations within the International Society for the Study and Prevention of Perinatal and Infant Death’s (ISPID)‘s guidelines, while the approach taken to discuss shared sleep from via Risk Minimisation vs. Risk Elimination was also evaluated using a coding framework. No organisation’s document/s contradicted ISPID’s guidelines, although there was variation in the quantity included. The approaches taken towards shared sleep by organisations were diverse between Risk Elimination and Risk Minimisation. Strategies to engage in safer shared sleep were provided by less than half of the organisations, as was the acknowledgement of familial, cultural, or logistical preferences for shared sleep, or that shared sleep may also occur unintentionally. Most organisations recommended that infants be breastfed but did not discuss the bi-directional link between breastfeeding and shared sleeping. Organisations need to provide consistent messaging on infant safer sleep to avoid public confusion. The adoption of a Risk Minimisation approach with clearer messaging provides considerations for informed choice, and strategies for safer shared sleeping; intentional or unintentional.

Determining Urinary Bile Acid Profiles to Predict Maternal and Neonatal Outcomes in Patients with Intrahepatic Cholestasis of Pregnancy

Objective: Intrahepatic cholestasis of pregnancy (ICP) is associated with an elevated risk of adverse perinatal outcomes, including perinatal morbidity and mortality. The objectives of this study were to evaluate the bile acid (BA) metabolism profiles in the urine of patients with ICP and to investigate the association between specific BAs and maternal and neonatal outcomes in patients with ICP. Methods: A total of 127 Chinese women with ICP and 55 healthy pregnant women were enrolled in our retrospective study. Spot urine samples and clinical data were collected from pregnant women from January 2019 to December 2022 at the First Affiliated Hospital of Chongqing Medical University, Chongqing. Based on total bile acid (TBA) levels, the ICP group was subdivided into mild (10–40 μmol/L) and severe (≥40 μmol/L) ICP groups. Patients in the ICP group were further divided into two categories according to neonatal outcomes: an ICP with adverse pregnancy outcomes group and an ICP with non-adverse pregnancy outcomes group. Metabolites from maternal urine were collected and analyzed using ultra-high-performance liquid chromatography–triple quadrupole time-of-flight mass spectroscopy (UPLC-triple TOF-MS). Results: Significant differences were observed between the mild and severe ICP groups in the onset time of symptoms, gestational weeks at time of ICP diagnosis, the duration of using ursodeoxycholic acid (UDCA) drugs during pregnancy, gestational age at delivery, premature delivery, and cesarean delivery. The expression levels of the composition of different urinary bile acids including THCA, TCA, T-ω-MCA, TCA-3-S, TCDCA-3-S, TDCA-3-S, GCDCA-3-S, DCA-3-G and GDCA-3-G were remarkably higher in the ICP with adverse pregnancy outcomes group than those in the ICP with non-adverse pregnancy outcomes group and the control group. The single-parameter model used to predict adverse pregnancy outcomes in ICP had similar areas under the curve (AUCs) of the receiver operating characteristic (ROC), ranging from 0.755 to 0.869. However, an AUC of 0.886 and 95% CI were obtained by the index of combined urinary bile acids in multiple prediction models (95% CI 0.790 to 0.983, p &lt; 0.05). TCA-3-S in the urinary bile acids had a strong positive correlation with the aspartate aminotransferase (AST) level (r = 0.617, p &lt; 0.05). Furthermore, TCDCA-3-S and GCDCA-3-S in the urinary bile acids had a strong positive correlation with the alanine aminotransferase (ALT) level (r = 0.607, p &lt; 0.05; r = 0.611, p &lt; 0.05) and AST level (r = 0.629, p &lt; 0.05; r = 0.619, p &lt; 0.05). Conclusions: Maternal urinary bile acid profiles were prominent for the prognosis of maternal and neonatal outcomes of ICP. Elevated levels of TCA-3-S, TCDCA-3-S, and GCDCA-3-S in urine might be important predictors for indicating adverse pregnancy outcomes in ICP.

Comparison of vaginal breech deliveries with and without magnetic resonance imaging in primigravidas: a retrospective cohort analysis and literature review.

Pelvimetry is often recommended in primiparous patients before offering vaginal breech delivery. Later studies show a reduction in perinatal mortality in women undergoing pelvimetry while earlier studies show the opposite. Magnetic resonance imaging (MRI), considered a new technology in 1990, has become the more expensive method for pelvimetry with lower-radiation, believed to prevent unnecessary cesarean sections and "falsely attempted vaginal deliveries". This retrospective cohort study (November 2019-February 2024) involved 160 primigravidas with breech presentation. The deliveries were attended by a team of experienced obstetricians (defined as attending at least 20 vaginal breech deliveries per year). Our cohort without MRI was compared with four study cohorts with MRI that were also used in a 2022 systematic review assessing delivery outcomes. Neonatal outcomes, cesarean section rate and vaginal delivery rate were compared. Umbilical artery pH was significantly lower in two study cohorts (Hoffmann et al. 2016 7.18 vaginal vs. 7.24 caesarean section (p < 0.001), our cohort 7.19 vaginal vs. 7.27 cesarean section (p < 0.001)). The vaginal delivery rate without MRI (our cohort) was 65.6%. In studies with prior MRI as a selection criterion, the rate was between 65.4% and 67.5% (Hoffmann, Van Loon, Klemt). 25.5% of our patients who had to be delivered by cesarean had non-reassuring fetal heart tones in the second stage of labor. Only 4.4% of the patients attempted delivery with epidural anesthesia. Pelvimetry has not been shown to predict neonatal outcome and there is still no consensus on the interpretation of MRI measurements. Many authors argue, as confirmed by our results, that the outcomes are not dependent on pelvimetry, but on the competence of the obstetric delivering team.

Perinatal intrusions: A window into perinatal anxiety disorders.

Mental health is the leading cause of preventable perinatal maternal mortality. Studying perinatal intrusions can shed light on determinants of maternal mental health.

Nano-formulated curcumin uptake and biodistribution in the fetal growth restricted newborn piglet brain.

Fetal growth restriction (FGR) affects 5% to 10% of all pregnancies in developed countries and is the second most leading cause of perinatal mortality and morbidity. Life-long consequences of FGR range from learning and behavioral issues to cerebral palsy. To support the newborn brain following FGR, timely and accessible neuroprotection strategies are needed. Curcumin-loaded polymeric nanoparticles, which have been widely explored for the treatment of cancer, neurological disorders, and bacterial infections, have the potential to prevent and mitigate pathogenic inflammatory processes in the FGR brain. Curcumin is a hydrophobic molecule with poor aqueous solubility and therefore has been incorporated into nanoparticles to improve solubility and delivery. However, curcumin loading in many nanoparticles can be limited to 10% by weight or lower. Here, we first optimize the formulation process of curcumin-loaded polymeric nanoparticles to find a tunable, reproducible, and stable formulation with high curcumin loading and encapsulation efficiency. We establish a curcumin formulation with 39% curcumin loading and > 95% curcumin encapsulation efficiency. Using this formulation, we assessed the biodistribution of polymeric nanoparticles in FGR piglets and normally grown (NG) piglets following different administration routes and evaluated brain cellular uptake. We show a significant amount of nanoparticle accumulation in the brain parenchyma of neonatal piglets as early as 4h after intranasal administration. Nanoparticles colocalized in microglia, a therapeutic target of interest in FGR brain injury. This study demonstrates the potential of curcumin-loaded nanoparticles to treat neuroinflammation associated with FGR in the newborn.

Influence of time of birth in early neonatal mortality and morbidity: retrospective cohort study

BackgroundA key target of the 2030 Sustainable Development Goals is to eliminate preventable deaths in newborns and children under 5. This study aimed to estimate the effect of time of...

The Impact of Maternal Nutrition Status on Maternal and Fetal Outcomes: A Prospective Observational Study

ABSTRACT Background: Maternal body mass index (BMI) significantly influences both maternal and fetal outcomes. Changing socioeconomic factors in India have led to a rise in both obesity due to lifestyle factors and malnutrition due to poverty. Each extreme of BMI—underweight and overweight—has distinct risks. Overweight and obese women face complications, such as gestational diabetes, gestational hypertension, and macrosomia, while underweight women are at higher risk of conditions, like intrauterine growth restriction (IUGR), low birth weight, and anemia. Materials and Methods: This observational study was conducted over nine months from September 2019 to June 2020, involving 850 pregnant women attending the gynecology outpatient department (OPD) at a tertiary hospital. First-trimester BMI was calculated to classify patients as underweight (&lt;18.5), normal weight (18.5–22.9), overweight (23–24.9), pre-obese (25–29.9), or obese (≥30). Data collection included personal and medical history, physical and obstetric examinations, and monitoring of maternal and fetal outcomes. Results: The study found that women at the extremes of BMI experienced higher rates of adverse outcomes. Obese and overweight women showed increased risks of gestational diabetes, hypertension, preeclampsia, cesarean deliveries, and postpartum hemorrhage. Conversely, underweight women had a higher incidence of IUGR, anemia, preterm birth, and increased perinatal mortality. Conclusion: Both high and low maternal BMI are associated with distinct risks for adverse pregnancy outcomes. Preconception counseling and lifestyle guidance for women of reproductive age may reduce the incidence of these complications, emphasizing the importance of optimal weight management for improved maternal and fetal health outcomes.

Fetal outcomes and associated factors of antepartum hemorrhage in Ethiopia: A systematic review and meta-analysis.

Antepartum hemorrhage (APH) is a significant obstetric complication characterized by bleeding from the genital tract before the onset of labor. It poses serious risks to both maternal and fetal health, with potential outcomes including preterm birth, low birth weight, and increased perinatal mortality. In Ethiopia, where access to comprehensive prenatal care and emergency obstetric services may be limited, the impact of APH on fetal outcomes is a pressing concern. Despite the gravity of this condition, there is a lack of synthesized evidence on its prevalence and the associated risk factors specific to the Ethiopian context. This systematic review and meta-analysis aim to consolidate existing research on the fetal outcomes of APH and identify the key factors contributing to its incidence and severity in Ethiopia. Following the PRISMA checklist guidelines, this study concentrated on research undertaken in Ethiopia. Comprehensive searches across multiple databases Google Scholar, Google, Web of Science, and PubMed yielded six pertinent studies. Data were systematically gathered using a structured checklist and analyzed with STATA version 14. The Cochrane Q test and the I² statistic were utilized to assess heterogeneity. Additionally, publication bias was examined using Egger's weighted regression, a funnel plot, and Begg's test. This study reviewed 525 research articles that included a total of 22,914 participants. Our meta-analysis revealed that the pooled prevalence of perinatal mortality due to antepartum hemorrhage in Ethiopia is 21.79% (95% CI: 12.32-31.25). Key factors influencing perinatal mortality associated with antepartum hemorrhage included living in rural areas (OR = 1.62, 95% CI: 1.33-1.98), delays in seeking medical care for over 12 hours (OR = 5.43, 95% CI: 1.01-29.14), prematurity (OR = 9.00, 95% CI: 5.39-15.03), and experiencing severe vaginal bleeding prior to arrival at a medical facility (OR = 7.04, 95% CI: 2.14-23.13). The study reveals a high perinatal mortality rate of 21.79% associated with antepartum hemorrhage in Ethiopia. Contributing factors include rural residence, delays in seeking care, prematurity, and severe vaginal bleeding. To reduce mortality, improve rural healthcare, strengthen emergency systems, and enhance prenatal care. Public education on early intervention and specialized care for premature infants are also essential. Collaboration among healthcare providers, government, and NGOs is crucial for effective, sustainable solutions.

Bacille Calmette-Guérin-specific IgG titres among infants born to mothers with active tuberculosis disease in Uganda.

Infants born to mothers with active tuberculosis disease (ATB) are at risk of poor clinical outcomes such as low birth weight and perinatal mortality. However, little is known about the influence of maternal ATB exposure on their vaccine responses during infancy. The study explored how maternal ATB affects infants' vaccine responses, hypothesising reduced responses to Bacille Calmette-Guérin (BCG) and other infant vaccines. This was a case-control study with a longitudinal component of infants born to mothers with bacteriologically confirmed ATB (cases) and infants born to mothers without ATB (controls) carried out between September 2021 and June 2022. Quantitative BCG, diphtheria, tetanus, and measles-specific IgG ELISA assays were performed on infant plasma harvested from lithium-heparin blood collected on first encounter after birth (0), at 3, 6, and 9 months. We used prism v10.1.2, mixed-effects modelling, and Tukey's multiple comparison testing to determine mean differences (MD) between the cases and controls at all time points. Exposed infant cases had reduced IgG titres to BCG at baseline compared to the controls (p = 0.032), with a mean of 125.8 vs. 141.1 IU/mL, respectively. This difference was, however, not sustained at the other time points. Similarly, we demonstrated trends towards reduced responses to tetanus, diphtheria, and measles vaccines among infant cases at baseline and three months. However, the trend was not sustained at months six and nine. The mean titres for tetanus at baseline and 3 months for cases versus controls are 1.744 vs. 2.917 IU/mL (p < 0.0001) and 1.716 vs. 2.344 IU/mL (p = 0.018), respectively. The mean titres for diphtheria at 3 months for cases versus controls were 0.022 vs. 0.075 IU/mL (p = 0.006), respectively. We have demonstrated that maternal TB disease influences vaccine responses to BCG and other infant vaccines. This has implications for increased risk of childhood TB and other preventable diseases. Not applicable.

Clinical Profile and Outcome of Neonates Admitted to the Neonatal Care Unit at Jalalabad Ragib-Rabeya Medical College Hospital, Sylhet

The neonatal mortality rate is still high in Bangladesh. It is crucial to identify areas where health care can be enhanced in order to improve newborn outcomes. The objective of this study was to describe the reasons for admission and the magnitude of neonatal mortality in the neonatal care unit of Jalalabad Ragib-Rabeya Medical College Hospital. This cross-sectional study was conducted between the periods of 1st January 2018 and 30th June 2018. Data were collected from the inpatient record files at the hospital record section. A total of 854 patients were included in the study. Among them, males were 57.4% and 42.6% were females. Most of the admitted neonates (78.7%) were inborn. Prematurity was present in 23.6% of neonates. The majority of the neonates (76.4%) were admitted within 24 hours of birth. The most common reasons for neonatal admission were low birth weight (44.8%), neonatal sepsis (42.6%), asphyxia (40.6%), neonatal jaundice (24.8%), hypoxic-ischemic encephalopathy (10.7%), congenital anomaly (8.1%), and infants of diabetic mothers (5%). The overall death rate was 11%. Sepsis (60.6%), LBW (59.6%), asphyxia (55.3%), and prematurity (51.1%) were the main contributors to neonatal death. Prematurity, birth weight &lt;1500 grams, outborn baby, vaginal delivery, birth asphyxia, and sepsis were all associated with a higher risk of neonatal mortality (p&lt;0.05). Low birth weight, sepsis, asphyxia and prematurity were the leading causes of neonatal admission and mortality in our study. Preventing asphyxia and sepsis, as well as improving the survival of preterm and low-birth-weight newborns, must be prioritized. Jalalabad Med J 2022; 19 (2): 60-66

Do Antenatal Interventions Improve Maternal and Perinatal Outcomes for Migrant Women Living in High-Income Countries and What Guidelines Exist for Migrant Women? A Systematic Review and Meta-Analysis.

Given the rise in migrant women giving birth in high-income countries (HICs) there is a need to identify and evaluate the efficacy of existing interventions that address disparities in adverse pregnancy outcomes experienced by migrant women. This review aims to identify any antenatal interventions offered to migrant women living in HICs, evaluate their efficacy at improving perinatal and maternal adverse outcomes, and to identify and evaluate pregnancy management guidelines relating to migrant status or ethnicity-specific practices or recommendations. Medline, Embase, CINAHL, Scopus, TRIP, ProQuest, and the International Guidelines Library were searched from January 2010 to March 2023. English-language randomized controlled trials, mixed-methods, and observational studies reporting perinatal and maternal outcomes in women living in HICs receiving a migrant-specific antenatal intervention. An additional search of any pregnancy management guidelines relating to migrant status or ethnicity-specific practices or recommendations was completed. Two authors independently conducted data extraction. Outcomes of interest included perinatal (stillbirth, neonatal death, 5-min post-delivery Apgar score < 7, NICU admission, small for gestational age, large for gestational age, low birth weight, and preterm birth) and maternal outcomes (mortality, gestational diabetes, gestational hypertension, pre-eclampsia, caesarean birth, instrumental birth, and induction of labour). Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated and pooled for meta-analysis using a random-effects model. All studies and guidelines were assessed using relevant risk assessment tools. Six studies met the inclusion criteria for this review. Meta-analysis showed that infants born to women offered a migrant-specific antenatal intervention had lower odds of stillbirth (OR 0.60 95% CI 0.37-0.97, p = 0.04, I2 = 0%) when compared to those in the standard care group. However, the use of migrant-specific interventions increased the odds of labor induction (OR 1.38 95% CI 1.27-1.49, p = < 0.01, I2 = 0%). Additionally, we identified 18 guidelines; however, no migrant or ethnicity-specific recommendations were supported by high-level evidence. Several migrant-specific antenatal interventions exist for migrant women living in HICs. These include fetal monitoring, group antenatal care programs, and a cultural training program for midwives. Despite heterogeneity between interventions, together they reduced the odds of stillbirth. Of the pregnancy management guidelines identified, most recommendations were largely based on findings from systematic reviews of observational and cohort studies, highlighting the lack of higher-quality evidence from clinical trials currently available.

Prognosis for fetuses with isolated severe growth retardation from 23 gestational weeks with an initial assessment unfavorable to an active management.

Prognosis for fetuses with isolated severe growth retardation from 23 gestational weeks with an initial assessment unfavorable to an active management.

Insights into the Global and Mexican Context of Placental-Derived Pregnancy Complications

Placental-derived pregnancy complications encompass a range of disorders that hinder optimal fetal development, significantly impacting maternal and neonatal health outcomes. Key conditions include placental insufficiency, preeclampsia, fetal growth restriction (FGR) or intrauterine growth restriction (IUGR), fetal overgrowth, and gestational diabetes mellitus (GDM), which together contribute to a heightened risk of preterm birth, perinatal mortality, and long-term developmental challenges in affected infants. These complications are particularly notable because they generate approximately 80% of pregnancy disorders and pose significant public health concerns across diverse global contexts. Their management continues to face challenges, including a lack of consensus on diagnostic criteria and varied implementation of care standards. While imaging techniques like magnetic resonance imaging (MRI) and Doppler ultrasound have emerged as critical tools in clinical assessment, disparities in access to such technologies exacerbate existing inequalities in maternal and fetal health outcomes. Maternal and pregnancy care is a broad range of services aimed at promoting the well-being of women throughout the perinatal period. However, access to these services is often limited by economic, geographical, and sociocultural barriers, particularly for marginalized groups and women in low- and middle-income countries (LMICs). The implementation of targeted interventions designed to address specific obstacles faced by disadvantaged populations is a crucial component of bridging the gap in health equity in maternal care. Public health authorities and policymakers strive to develop evidence-based strategies that address the interplay between healthcare access, socioeconomic factors, and effective interventions in order to mitigate the adverse effects of placental-derived pregnancy complications. Continued research and data collection are essential to inform future policies and practices to improve outcomes for mothers and infants.