Preterm Neonatal Death Research Articles

Preterm Neonatal Mortality and Its Determinants at a Tertiary Hospital in Western Uganda: A Prospective Cohort Study.

BackgroundPrematurity contributes greatly to the neonatal mortality burden in sub-Saharan Africa. This study evaluated the proportion of preterm neonatal death, medical conditions at admission, and determinants of mortality of preterm neonates in the neonatal intensive care unit (NICU) of a tertiary hospital in Western Uganda.Materials and MethodsA prospective cohort study of 351 consecutively enrolled preterm neonates was conducted from March to June 2019. Interviewer-administered questionnaires and physical assessment of neonates were used to obtain socio-demographic and clinical data for mothers and their preterm neonates. Descriptive statistics for participants’ characteristics were generated, while bivariate and multivariate logistic regression models were fitted so as to establish the determinants of mortality outcome. A p-value <0.05 was considered statistically significant.ResultsIn-hospital neonatal mortality of 31.6% (95% CI: 26.9–36.7) was noted, with 65.8% of deaths occurring within 72 hours from admission. The most common medical conditions at admission were: hypothermia (67.2%), respiratory distress syndrome (43.0%), small for gestational age (15.7%), and perinatal asphyxia (14.5%). Under multivariate regression modelling, maternal age ≥35 years (AOR: 4.5; 95% CI: 1.35–15.31), no antenatal care (AOR: 4.7; 95% CI: 1.05–21.21), >4 ANC visits (AOR: 5.3; 95% CI: 1.88–15.21), neonatal resuscitation (AOR: 3.4; 95% CI: 1.66–6.82), outborn status (AOR: 2.3; 95% CI: 1.20–4.50), singleton pregnancy (AOR: 3.7; 95% CI: 1.74–7.89), <28 weeks’ gestation (AOR: 12.0; 95% CI: 2.24–64.27), and male sex (AOR: 2.0; 95% CI: 1.04–3.74), respiratory distress syndrome (AOR: 2.6; 95% CI: 1.22–5.70), apnea (AOR: 6.2; 95.5% CI: 1.09–35.38), hypothermia (AOR: 2.3; 95% CI: 1.09–4.92), and small for gestational age (AOR: 4.7; 95% CI: 2.06–10.74) were significantly associated with mortality.Conclusion and RecommendationsIn-hospital mortality of preterm neonates was high. We identified various maternal and neonatal risk factors, indicating a need for stakeholders to enhance efforts towards prevention of preterm-associated complications and optimize facility-based continuum of care.

Improving Neonatal Survival Through Preventing Infections in Resource-Constrained Environment: A Quality Improvement Project

Background: A recent study using minimally invasive tissue sampling at Chris Hani Baragwanath Academic Hospital (CHBAH), a public tertiary-care hospital in South Africa, reported that 70% of preterm neonatal deaths were due to healthcare-associated infections (HAIs). Based on these findings, CHBAH in collaboration with the CDC conducted an infection prevention and control (IPC) assessment and identified IPC gaps: limited training and mentorship of staff, medication preparation near the patient zone, and inadequate equipment cleaning and a high infection rates. We implemented a program from February 2019 to February 2020 to address these identified gaps, with the aim of reducing the neonatal sepsis rate. Methods: We focused our interventions on 3 essential activities in the neonatal wards: (1) conducting medication compounding in a safe environment with dedicated trained clinical pharmacy personnel; (2) improving cleaning and reprocessing of medical equipment through use of dedicated ward assistants; and (3) improving infection control–related behavior of frontline healthcare staff through on-site IPC mentorship and training. We captured data on process measures including medication errors and hand hygiene and outcome measures. We also looked at rates of infection, defined as positive cultures from blood and CSF per 1,000 patient days. Results: A NICU satellite pharmacy was established in February 2019 and was managed by a lead pharmacist and pharmacy assistants. Following the intervention, medication errors were reduced from 17% in March to 2% in September; nursing staff previously dedicated to medication preparation were able to spend more time in patient care. Furthermore, 4 full-time ward-assistants were hired in February 2019, and equipment is now cleaned using a standardized protocol in a dedicated cleaning area. A dedicated IPC team was assembled in January 2019 to develop standard operating procedures and conduct frequent trainings with healthcare personnel on IPC practices. Since these trainings were implemented, hand hygiene compliance improved from 25% to 48% over a 4-month period. There has been no significant change in blood/CSF infection rates from before implementation (2018): 17.7 per 1,000 patient days (95% CI, 16.7–18.8) compared to rate of 19.1 per 1,000 patient days (95% CI, 17.7–20.6) after implementation (March–September 2019), with a rate ratio of 1.08 (95% CI, 0.98–1.19). Conclusions: The impact of this program was demonstrated through process improvements and reduction in medication errors. However, to date there has been no change in the overall infection rates, suggesting that additional IPC interventions are needed or that other factors are contributing to the high infection rates.Funding: NoneDisclosures: None

Rates of Maternal and Perinatal Mortality and Vertical Transmission in Pregnancies Complicated by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-Co-V-2) Infection: A Systematic Review.

To ascertain the frequency of maternal and neonatal complications, as well as maternal disease severity, in pregnancies affected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. MEDLINE, Ovid, ClinicalTrials.gov, MedRxiv, and Scopus were searched from their inception until April 29, 2020. The analysis was limited to reports with at least 10 pregnant patients with SARS-CoV-2 infection that reported on maternal and neonatal outcomes. Inclusion criteria were pregnant women with a confirmed diagnosis of SARS-CoV-2 infection. A systematic search of the selected databases was performed by implementing a strategy that included the MeSH terms, key words, and word variants for "coronavirus," "SARS-CoV-2," "COVID-19," and "pregnancy.r The primary outcomes were maternal admission to the intensive care unit (ICU), critical disease, and death. Secondary outcomes included rate of preterm birth, cesarean delivery, vertical transmission, and neonatal death. Categorical variables were expressed as percentages with number of cases and 95% CIs. Of the 99 articles identified, 13 included 538 pregnancies complicated by SARS-CoV-2 infection, with reported outcomes on 435 (80.9%) deliveries. Maternal ICU admission occurred in 3.0% of cases (8/263, 95% CI 1.6-5.9) and maternal critical disease in 1.4% (3/209, 95% CI 0.5-4.1). No maternal deaths were reported (0/348, 95% CI 0.0-1.1). The preterm birth rate was 20.1% (57/284, 95% CI 15.8-25.1), the cesarean delivery rate was 84.7% (332/392, 95% CI 80.8-87.9), the vertical transmission rate was 0.0% (0/310, 95% CI 0.0-1.2), and the neonatal death rate was 0.3% (1/313, 95% CI 0.1-1.8). With data from early in the pandemic, it is reassuring that there are low rates of maternal and neonatal mortality and vertical transmission with SARS-CoV-2. The preterm birth rate of 20% and the cesarean delivery rate exceeding 80% seems related to geographic practice patterns. PROSPERO, CRD42020181497.

The adverse maternal and perinatal outcomes of adolescent pregnancy: a cross sectional study in Hebei, China

BackgroundThe adverse pregnancy outcomes caused by teenage pregnancy are major public health problems with significant social impact. While China is the most populous country in the world, and 8.5% of the women aged 10–50 years are adolescent women, we aimed to analyze the adverse maternal and perinatal outcomes of the adolescent pregnancy in Hebei Province, China.MethodsThere were 238,598 singleton pregnant women aged 10–34 years from January 1, 2013 to December 31, 2017 in the database of Hebei Province Maternal Near Miss Surveillance System (HBMNMSS). The 238,598 pregnant women were divided into two groups: adolescent group (aged 10–19 years) and adult group (aged 20–34 years). The adolescent group was divided into two subgroups (aged 10–17 years, aged 18–19 years), the adult group was divided into two subgroups (aged 20–24 years, aged 25–34 years). We compared the risk of adverse pregnancy outcomes using univariate and multivariate logistic regression. We also made a stratified analysis of nulliparous and multiparous adolescent pregnancy.ResultsCompared with women aged 20–34 years, women aged 10–19 years had lower risk of cesarean delivery [adjusted risk ratio (aRR): 0.75, 95% confidence interval (CI): 0.70–0.80], gestational diabetes mellitus (GDM) (aRR: 0.55, 95%CI: 0.41–0.73). Women aged 10–19 years had higher risk of preterm delivery (aRR: 1.76, 95%CI: 1.54–2.01), small for gestational age (SGA) (aRR: 1.19, 95%CI: 1.08–1.30), stillbirth (aRR: 2.58, 95%CI: 1.83–3.62), neonatal death (aRR: 2.63, 95%CI: 1.60–4.32). The adolescent women aged 10–17 years had significantly higher risk of stillbirth (aRR: 5.69, 95%CI: 3.36–9.65) and neonatal death (aRR: 7.57, 95%CI: 3.74–15.33) compared with the women aged 25–34 years. Younger adults (20–24 years) also had higher risks of preterm delivery (aRR: 1.26, 95%CI: 1.20–1.32), stillbirth (aRR: 1.45, 95%CI: 1.23–1.72), and neonatal death (aRR: 1.51, 95%CI: 1.21–1.90) compared with women aged 25–34 years. The structural equation model showed that preterm delivery and cesarean delivery had an indirect effect on neonatal death in adolescent pregnancy.ConclusionsThe adolescent pregnancy was related to adverse perinatal (fetal and neonatal) outcomes, such as preterm delivery, stillbirth and neonatal death, especially in younger adolescent pregnancies.

Ureaplasma parvum induces preterm birth by triggering immune responses in the fetus and at the maternal-fetal interface

Abstract Preterm birth is the leading cause of neonatal morbidity and mortality worldwide. One of every four preterm births is due to intra-amniotic infection, most commonly associated with Ureaplasma species. However, a causal link between Ureaplasma species and adverse pregnancy outcomes, as well as the triggered host immune responses, has not been investigated. Molecular microbiological surveys first revealed that Ureaplasma parvum is the most common bacterium in women with intra-amniotic infection. Ultrasound-guided intra-amniotic injection of U. parvum in pregnant mice resulted in preterm birth and neonatal death. Specific qPCR revealed that U. parvum invaded specific fetal (lung, intestine, spleen, fetal membranes, and placenta) and maternal (decidua, uterus, and cervix) compartments. Consistently, U. parvum induced a strong inflammatory response in the amniotic cavity, fetal membranes, placenta, and fetal lung and spleen, as well as at the maternal-fetal interface. However, U. parvum neither invaded the non-reproductive maternal organs nor induced a maternal systemic inflammatory response. An ex vivo model of intra-amniotic infection showed that U. parvum elicits pro-inflammatory responses in human amnion epithelial cells. Lastly, the treatment of U. parvum-injected mice with clarithromycin, a clinically relevant macrolide, prevented preterm birth and neonatal death. Collectively, this investigation provides a causal link between U. parvum and adverse pregnancy outcomes, and yields insights into the host immune responses triggered by this genital mycoplasma. Importantly, these data support the use of clarithromycin in the treatment of Ureaplasma-associated intra-amniotic infection leading to preterm birth.

M2-polarized macrophages as a potential cell therapy to mitigate inflammation-induced preterm birth

Abstract Preterm birth is the leading cause of neonatal morbidity and mortality worldwide. A substantial fraction of spontaneous preterm births are due to intra-amniotic inflammation; yet, to date, no anti-inflammatory strategies exist to treat this clinical condition. We propose that boosting homeostatic immune cells that are reduced at the maternal-fetal interface of women who underwent preterm birth can serve as a novel strategy to prevent this syndrome. First, using immunophenotyping, we showed that women who experience preterm birth have low proportions of M2-polarized macrophages at the maternal-fetal interface. Next, we tested whether adoptive transfer of M2-polarized macrophages could prevent intra-amniotic inflammation-induced preterm birth in mice. Bone marrow-derived myeloid cells (BMDM) from non-pregnant mice were differentiated and polarized towards M2 macrophages, as proven by flow cytometry. The adoptive transfer of M2-polarized macrophages, but not BMDM, prevented preterm birth and neonatal death. To increase the translational value, M2-polarized macrophages from mid and late pregnancy were also tested, and those from mid pregnancy were more effective in preventing preterm birth. Using GFP-positive M2-polarized macrophages, we showed that adoptively transferred cells migrate into the maternal (lung, liver, uterus) and fetal (placenta, lung) tissues as well as the maternal-fetal interface prior to preterm birth. The adoptive transfer of M2-polarized macrophages dampened pro-inflammatory responses in the maternal circulation and amniotic cavity. Collectively, these findings raise the prospect of a novel cellular anti-inflammatory approach to prevent preterm birth and adverse neonatal outcomes.

Impact of Depression in Teenage Pregnancy [17K

INTRODUCTION: Teenage pregnancy remains a public health concern. Maternal complications include increased C-section and instrumental deliveries. Infant complications include preterm births and neonatal death. Societal implications seen in teenage mothers include increased financial burden, unemployment, poor academic achievement, and physical abuse. In this study, we investigated a correlation between a diagnosed adolescent depression and pregnancy during adolescence (&lt;20 years old). METHODS: We conducted a retrospective review of female patients, under the age of 20, diagnosed with depression and/or adolescent pregnancy at Texas Tech University Health Sciences Center clinics (including Obstetrics and Gynecology, Pediatric, and Family Medicine clinics) in Amarillo, Texas from January 1, 2013 to December 31, 2016 and conducted Z-test to analyze the statistical significance. IRB approval was obtained. RESULTS: Of the 490 teenage girls identified, 171 (34.9%) were pregnant but not depressed, 220 (44.9%) were depressed but not pregnant, and 99 (20.2%) were both depressed and pregnant. Of the 99 teenage girls, 35 (35.4%) of the patients had depression prior to pregnancy, 29 (29.3%) had PPD (postpartum depression), 19 (19.2%) had depression after conception without PPD, and 16 (16.2%) had depression after conception with unknown PPD. CONCLUSION: Research suggests that childbearing does not necessarily cause psychological distress among teenagers. However, after filtering out the data for PPD and those with indeterminate history, the result showed that teens were, on average, depressed first, and became pregnant after. This research shows that depression remains an important risk factor for teen pregnancy. Public policy and medical management should be encouraged to address this.

A comparison of neonatal outcomes between adolescent and adult mothers in developed countries: A systematic review and meta-analysis.

Evidence suggests that adolescent pregnancies are at increased risk of adverse neonatal outcomes compared to adult pregnancies; however, there are significant inconsistencies in the literature, particularly in studies conducted in developed countries.The objective of this study therefore is to systematically review the current literature with regard to the relationship between adolescent pregnancy and neonatal outcomes.A literature search was conducted in eight electronic databases (AMED, ASSIA, Child Development and Adolescent Studies, CINAHL, Cochrane Library, Health Source: Nursing, Maternity and Infant Care, MEDLINE and Scopus. The reference lists of included studies were also hand searched.Studies were included if: they were conducted in countries with very high human development according to the United Nations Human Development Index; reported at least one comparison between adolescents (19 years or under) and adult mothers (20–34 years); and were published between January 1998 and March 2018.Studies were screened for inclusion and data extracted by one reviewer. A second reviewer independently reviewed a sub-set of studies. Disagreements were resolved by consensus. Meta-analysis was performed using RevMan 5.3 using crude counts reported in the included studies. Sub-group analyses of adolescents aged 17 and under and 18–19 were conducted. Pooled analysis of adjusted odds ratios was also undertaken in order to consider the effect of confounding factors. Meta-analysis effect estimates are reported as risk ratios (RR) and pooled association as adjusted odds ratios (aORs). Point estimates and 95% confidence intervals are presented.After removal of duplicates a total of 1791 articles were identified, of which 20 met the inclusion criteria.The results of the meta-analysis showed adolescents to have increased risk of all primary adverse outcomes investigated. Sub-group analysis suggests an increased risk of perinatal death and low birthweight for children born to adolescent mothers; 17 and under (perinatal death: RR 1.50, CI 1.32–1.71: low birthweight RR 1.43, CI 1.20–1.70); 18–19 (perinatal death RR 1.21, CI 1.06–1.37: low birthweight RR 1.10, CI 1.08–1.57). Mothers aged 17 and under were also at increased risk of preterm delivery (RR 1.64, CI 1.54–1.75). Analysis adjusted for confounders showed increased risk of preterm delivery (aOR 1.23, CI 1.09–1.38), very preterm delivery (aOR 1.22, CI 1.03–1.44) and neonatal death (aOR 1.31, CI 1.14–1.52).Findings show that young maternal age is a significant risk factor for adverse neonatal outcomes in developed countries. Adolescent maternal age therefore should be considered as a potential cause for concern in relation to neonatal health and it is recommended that health care professionals respond accordingly with increased support and monitoring.

Population-Based Estimation of the Preterm Birth Rate in Lilongwe, Malawi: Making Every Birth Count.

Objective The objective of this study was to perform a population-based estimation of the preterm birth (PTB) rate in regions surrounding Lilongwe, Malawi. Study Design We partnered with obstetrician specialists, community health workers, local midwives, and clinicians in a 50 km region surrounding Lilongwe, Malawi, to perform a population-based estimation of the PTB rate during the study period from December 1, 2012 to May 19, 2015. Results Of the 14,792 births captured, 19.3% of births were preterm, including preterm early neonatal deaths. Additional PTB risk factors were similarly prevalent including domestic violence, HIV, malaria, anemia, and malnutrition. Conclusion When performing a population-based estimation of the rate of PTB, including women without antenatal care and women delivering at home, the 19.3% rate of PTB is among the highest recorded globally. This is accompanied by a high rate of risk factors and comorbid conditions.

Survival and associated factors of mortality of preterm neonates admitted to Felege Hiwot specialized hospital, Bahir Dar, Ethiopia.

Background:The complication of prematurity is the second commonest cause of under-five mortality in Ethiopia. Amhara region has the highest neonatal mortality rate in the country. There was no previous study and this study aimed to assess the survival of preterm neonates and its associated factors of preterm neonatal mortality admitted to Felege Hiwot Specialized Hospital, Bahir Dar, Ethiopia, to take necessary action to maximize survival of preterm babies in developing countries.Methods:A retrospective cross-sectional study was conducted among 686 preterm neonates admitted in Felege Hiwot Specialized Hospital from 1 August 2017 to 30 July 2018. Kaplan–Meier survival curve was used to show the survival rate of preterm neonates and the multivariate Cox proportional hazards model was used to identify covariates of survival of preterm neonates. Those variables having a p-value less than 0.05 were statistically significant for the survival of preterm neonates.Result:Out of 686 preterm neonates admitted from 1 August 2017 to 30 July 2018, 49.1% neonates were improved and discharged and 36.1% died. The survival rate was 0%, 19.4%, 46.7% and 75% for gestational age <28 weeks, 28–31 + 6 weeks, 32–33 + 6 weeks and 34–36 + 6 weeks, respectively. In the multivariate Cox regression model, respiratory distress syndrome, necrotizing enterocolitis, asphyxia, hospital-acquired infection, birth weight, gestational age and place of delivery were significantly associated with time to death of preterm neonates at 95% confidence level (p < 0.05).Conclusion:The mortality rate (36.1%) of preterm neonates is unacceptably high in Felege Hiwot hospital compared to other similar hospitals in Ethiopia. More than 50% of preterm neonatal deaths can be prevented with available resources. Neonatal units with adequate and committed manpower, using a strict aseptic technique, proper follow-up, early detection and timely management of complications, are recommended to improve the survival of preterm neonates.

Care Practices, Morbidity and Mortality of Preterm Neonates in China, 2013\u20132014: a Retrospective study

This retrospective cohort study aimed to investigate the prevalence, morbidity, mortality and the maternal/neonatal care of preterm neonates and the perinatal risk factors for mortality. We included data on 13,701 preterm neonates born in 15 hospitals for the period 2013–2014 in China. Results showed a prevalence of preterm neonates of 9.9%. Most infants at 24–27 weeks who survived more than 12 hours were mechanically ventilated (56.1%). Few infants born before 28 weeks received CPAP without first receiving mechanical ventilation (8.1%). Few preterm neonates received antenatal steroid(35.8% at 24–27 weeks, 57.9% at 28–31 weeks, 57.0% at 32–33 weeks and 32.7% at 34–36 weeks). Overall mortality was 1.9%. Most of the deaths at 24–27 weeks of gestation occurred within 12 hours after birth, accounting for 68.1%(32/47), and within 12–72 hours after birth at 28–36 weeks of gestation, accounting for 47.4%(99/209). Rates of survival to discharge increased from 68.2% at 24–27 weeks, 93.3% at 28–31 weeks, 99.2% at 32–33 weeks to 99.4% at 34–36 weeks. The smaller of the GA, there was a greater risk of morbidities due to prematurity. Preterm birth weight (OR = 0.407, 95% CI 0.346–0.478), antenatal steroid (OR = 0.680, 95% CI 0.493–0.938), and neonatal asphyxia (OR = 3.215, 95% CI 2.180–4.741) proved to significantly influence the odds of preterm neonatal death. Overall, our results support that most of the preterm neonates at 28–36 weeks of gestation survived without major morbidity. Rate of survival of GAs less than 28 weeks was still low. Maternal and infant care practices need to be improved in the very preterm births.

Can transition to a cleaner fuel from Kerosene or firewood be beneficial in pregnant Nigerian women?

S02: Harmonizing insights from intervention studies, contextual information and resource availability to develop policy advocacy for clean cooking and domestic fuel adoption in Africa, Room 417, Floor 4, August 27, 2019, 10:30 AM - 12:00 PM Background/Aim: Exposure to household air pollution from cooking with solid fuel accounts for 3 million premature deaths yearly and has been linked to adverse pregnancy outcomes. In Nigeria, 70% of households cook with kerosene or firewood. A randomized controlled trial was undertaken in Ibadan, Nigeria to determine the impact of cooking with kerosene or firewood on personal exposures, the health of pregnant women and pregnancy outcomes. Methods: Three hundred twenty four pregnant women were randomized to either control (C-continued cooking using own kerosene/firewood stove; or intervention groups (E-received CleanCook stove). Ultrasonography and blood pressure measurements were performed at six visits during pregnancy. 72-hour personal exposure monitoring of particulate matter with diameter less than 2.5 micrometers (PM2.5) was performed in the second and third trimester. Birth outcomes (miscarriages, pre-term deliveries and birth weights) were recorded. Placenta was collected at birth and analyzed for chronic hypoxia and biomarker levels of hypoxia inducing factor. Results: Of the enrolled participants, 18 dropped out of the study (8 E, 10 C). Mean birthweight for the ethanol and control groups was 3076.2 and 2988.0g, respectively; the difference, 88.2g (95% confidence interval: -18.0g to 194.5g), was not statistically significant (p=0.103). However, after adjusting for marital status and BMI, the difference reached statistical significance (p=0.020). Average gestational age at delivery was significantly (p=0.015) higher in ethanol group (39.2 weeks) compared to controls (38.2 weeks). There were fewer preterm infants (<37 weeks), stillbirths, miscarriages, and neonatal deaths in the ethanol group compared to controls. The percentage of miscarriages, stillbirths, or neonatal deaths was twice as high in controls compared to the ethanol group (9.9% vs. 4.6%; p=0.037). The likelihood of developing hypertension at term and diastolic BP was significantly lower in the ethanol group. Conclusions: Replacing kerosene and firewood with ethanol in pregnant Nigerian women improved pregnancy outcomes.

Impact of Marijuana Legalization on Prevalence of Maternal Marijuana Use and Perinatal Outcomes.

We aimed to assess whether marijuana legalization was associated with a difference in prevalence of prenatal use or an increase in incidence of adverse perinatal outcomes. The present study is a retrospective cohort of September and October deliveries in the years 2012 through 2015 at a tertiary center in Colorado. Primary outcome of the study was use of marijuana, defined by self-report or biodetection. Secondary outcomes of the study included growth restriction, spontaneous preterm birth, stillbirth, preeclampsia, and neonatal or maternal death. Marijuana use prevalence was compared by year, and secondary outcomes between two periods, before and after the opening of the first recreational dispensary. A total of 2,392 pregnant women were included (1,165 before legalization and 1,227 after). More women used marijuana over the period of legalization (trend p = 0.01). Odds of marijuana use were higher after legalization versus before (adjusted odds ratio [aOR] = 1.8, 95% confidence interval [CI]: 1.2-2.6). Incidence of growth restriction was higher after legalization (2.9 vs. 5.1%, p = 0.0084). This difference persisted after adjustment for ethnicity and other drugs in multivariable modeling (aOR = 1.9, 95%CI: 1.2-3.0). The prevalence of prenatal marijuana use increased over the time of legalization. Further investigation into the population impact of legalization on obstetrical outcomes is warranted given the observed increase in growth restriction.

Pharmacological interventions for the prevention of fetal growth restriction: protocol for a systematic review and network meta-analysis

IntroductionFetal growth restriction (FGR) includes different conditions in which a fetus fails to reach the own full growth, and accounts for 28%–45% of non-anomalous stillbirths. The management of FGR is...

Effect of interpregnancy interval after a first pregnancy complicated by placental abruption, on adverse maternal and fetal outcomes in a second pregnancy

Background: For women who suffer from abruption in the first pregnancy, the extent to which birth spacing has an impact on maternal and fetal outcomes in a second pregnancy remains unclear.Objectives: To examine the effect of interpregnancy interval (IPI) after a first pregnancy complicated by placental abruption, on adverse maternal and fetal outcomes in a subsequent pregnancy.Study design: This was a population-based retrospective cohort study using maternally-linked Missouri birth registry from 1989 to 2005 (n = 2069). Exposure of interest was IPI and outcomes were placental abruption, preeclampsia, preterm birth, small for gestational age, cesarean delivery, and neonatal plus fetal deaths (neofetal death) in a second pregnancy. Logistic regressions were used to assess the association between IPI and the outcomes.Results: Compared with women with an IPI of 1–2 years, those with short IPI (<1 year) were more likely to experience preterm birth (aOR 3.01, 95% CI 1.71–5.28) and neonatal death (aOR 3.52, 95% CI 1.24–10.02) in their subsequent pregnancy. No significant associations between IPI and recurrent placental abruption or preeclampsia were detected.Conclusions: Women who become pregnant in less than a year’s time of an initial placental abruption are at increased risk for preterm birth and neofetal death in a subsequent pregnancy. Other ischemic placental disease conditions are also shown to have serious health implications for a woman’s next pregnancy.

Congenital Factor X deficiency in women: A systematic review of the literature.

Factor X deficiency (FXD) is a rare autosomal recessive bleeding disorder with a variable phenotypic severity. In women, heavy menstrual bleeding (HMB), recurrent ovulation bleeding with haemoperitoneum and bleeding complications in pregnancy such as retroplacental haematoma and postpartum haemorrhage have been reported. The aim of this review was to examine gynaecological problems and obstetric complications in women with congenital FXD. A total number of 49 relevant articles were identified, including 332 women, dating from 1960 to 2018. Heavy menstrual bleeding was reported in 72/284 (25%) women in total, 14/30 (47%) in case reports and 58/254 (23%) in 11 case series, 64% and 10% required blood products and blood transfusion, respectively. Haemoperitoneum from ovulation bleeding or ruptured haemorrhagic ovarian cyst requiring blood transfusion occurred in 8/322 (2.4%) women, six required surgical intervention, including oophorectomy in two. 31 pregnancies were reported in 19 women. There were four miscarriages (including a late miscarriage at 21weeks). There was a high rate of preterm birth and neonatal death occurring in eight (30%) and three (11%) of pregnancies reaching viability stage. Postpartum haemorrhage (PPH) occurred in six (22%) of deliveries, one requiring hysterectomy. In conclusion, women with FXD are at an increased risk of heavy bleeding during menstruation and ovulation as well as adverse pregnancy outcome and postpartum haemorrhage. Collaboration in a multidisciplinary team including an obstetrician/gynaecologist, a perinatologist and a haematologist is necessary for the prevention and management of these complications.

The effect of the cost of obstetric care on antenatal and postnatal healthcare utilization: Evidence from Armenia

The high cost of obstetric care is a common reason for late or no detection of preventable preterm labor, serious complications, long-term disabilities, and neonatal and maternal death. To resolve the debate of whether affordable, high-quality healthcare can be used as a policy tool to incentivize timely and more frequent checkups during and after pregnancy, we examine the causal effect of the Obstetric Care State Certificate (OSCS) program, which fully covered the costs of all antenatal services, consultations, medical exams, delivery and postnatal care in Armenia after 2008, on utilization of prenatal and postnatal care in the country. Evidence suggests that the reform had a significant, positive effect on care utilization during and after pregnancy, with the largest effects being elicited in the subsamples of women at high risk pregnancies, and mothers who have had a miscarriage or an abortion.

Survival and predictors among preterm neonates admitted at University of Gondar comprehensive specialized hospital neonatal intensive care unit, Northwest Ethiopia

BackgroundPrematurity accounts about 1 million neonatal deaths worldwide and the second causes of both neonatal and under five-child mortality. Neonatal mortality accounts for 43% of under-five child mortality in Ethiopia. From this preterm is the second leading cause of death and is steadily increased in low-income countries. Therefore, the aim of this study was to assess time to death and predictors among preterm neonates admitted in University of Gondar comprehensive specialized hospital neonatal intensive care unit North West Ethiopia 2018.MethodsInstitution-based retrospective follow-up study was conducted among 516 preterm neonates from January 2016 to March 2018. Data were extracted retrospectively from patients’ records using a pretested structured checklist. Descriptive summary statistics like median survival time, Kaplan Meier failure estimation curve and Log-rank test were computed. Bivariate and multivariable Gompertz parametric hazards models were fitted to identify the predictors of mortality. Hazard ratio with a 95% confidence interval was calculated and p-values < 0.05 were considered statistically significant.ResultsThe proportion of preterm neonatal death in this study was 28.8% (95%CI (25.1, 32.9)). Home delivery (AHR = 2.25, 95% CI (1.03, 4.88)), hyaline membrane disease (AHR =3.21, 95% CI (1.96, 5.25)), gestational age, (AHR = 0.82, 95% CI (0.74, 0.91)), cry immediately at birth (AHR = 1.74, 95% CI (1.19, 2.53)), kangaroo mother care (AHR = 0.24, 95%CI (0.11, 0.52)), presence of jaundice (AHR = 1.62, 95%CI (1.12, 2.54)) and hypoglycemia at admission (AHR = 1.75, 95%CI (1.21, 2.54)) were found to be significant predictors of time to death for preterm neonates.ConclusionProportion of preterm neonatal death in this study was high. Home delivery, Jaundice, hypoglycemia, gestational age, cry immediately at birth, kangaroo mother care and hyaline membrane disease were significant predictors of time to death.

A population-based comparison of preterm neonatal deaths (22-34 gestational weeks) in France and Ontario: a cohort study.

The management and outcomes of preterm births can vary greatly even among developed nations with the same access to medicine, technology and expertise. We aimed to compare aspects of obstetrical management and mortality for preterm infants in France and Ontario, Canada. The Better Outcomes Registry & Network (BORN) Information System in Ontario and Épidémiologique sur les petits âges gestationnels (EPIPAGE-2) in France collected information on maternal demographics, obstetrical characteristics, obstetrical interventions and neonatal outcomes for infants born between 22 and 34 weeks gestation. We used standardized covariate definitions and extracted data from 2011 (for EPIPAGE-2) and from 2012 and 2013 (for BORN) to conduct a cohort study comparing the 2 data sets (stratified into gestational age groups of 22-26, 27-31 and 32-34 wk) using multivariable logistic regression models. Mothers in the BORN cohort were older (30.7 yr v. 29.6 yr) but less likely to have gestational hypertension (13.4% v. 17.9%) than those in the EPIPAGE-2 cohort. Infants from EPIPAGE-2 had lower birth weights (1.3 kg v. 1.5 kg) and were more likely to be born in an institution with level 3 care (71.9% v. 55.8%). After adjustment for these differences, there was significantly higher neonatal mortality among infants from EPIPAGE-2 in the 22-26 week gestation age group (adjusted odds ratio 2.81; 95% confidence interval 1.17 to 6.74). Even after we adjusted for both intrinsic population differences and differences in management between Ontario and France, we found a higher rate of neonatal mortality at earlier gestational ages in France. This may be related to differences in ethical approaches and/or postnatal management and should be explored further.

Epidemiological investigation of perinatal deaths in Recife-Pernambuco: a quality assessment.

to evaluate the completeness of perinatal death investigation sheets, stratified by age components. descriptive study carried out in Recife, PE, in 2014. Among 308 perinatal deaths, 46 were excluded from this study due to association with congenital malformations, and 7 due to missing investigation sheets. Analysis included 255 deaths (160 fetal deaths, and 95 preterm neonatal deaths). The degree of completeness of 98 variables was calculated. They were aggregated into six blocks: identification, prenatal care, birth care, family characteristics, occurrence of death and conclusions and recommendations. the median rate of completeness for perinatal death investigation sheets was 85.7% (82.8% for records of fetal deaths and 89.5% for records of preterm neonatal deaths). The best-filled information block was "identification" (96.1%), as well as its components: fetal (94.7%) and preterm neonatal (97.9%). The worst was "prenatal care" (69.8%), along with its components: fetal (73.8%) and preterm neonatal (67.4%). investigation sheets had good completeness; there were differences between variables and components of perinatal death.