Prevalence Of Stillbirth Research Articles

Unearthing the Hidden Tragedy

Background: Stillbirths are very traumatic events to the parents, family, and obstetricians. Although a global public health crises, it has remained relatively hidden while their devastations continue unabated in different parts of the world. We have not evaluated this tragedy in our practice environment hence the need for this paper. Methods: This is a retrospective study involving all cases of stillbirths that occurred at the Alex Ekwueme Federal University Teaching Hospital, Abakaliki, over a 3-year period, 2017–2019. The case notes were gotten and relevant information was retrieved and analyzed. Results: The prevalence of stillbirths in our centre was 16.1 per 1000 deliveries or one stillbirth in 62 deliveries. Majority of our parturients who had stillbirths 89 (81.7%) were unbooked, 43 (39.5%) had only primary education, 16 (14.7%) had no education at all, and only 10 (9.2%) had tertiary education. The leading cause of stillbirths was abruptio placenta 27 (24.8%) followed by prolonged obstructed labor 22 (21.1%), intrauterine fetal death of unknown cause 18 (16.5%), and ruptured uterus 10 (9%). Seventy-three (67%) women were delivered by spontaneous vaginal delivery while 18 (16.5%) had a caesarean section. Thirty (27.5%) women had postpartum hemorrhage. None of the dead babies had an autopsy performed on them. Conclusion: The prevalence of stillbirth in our centre is unacceptably high and majority of the causes are preventable. There is an urgent need for public enlightenment to highlight this silent tragedy and mobilize efforts toward its prevention. Carrying out autopsies on stillbirths especially those with unexplained causes will help elucidate some of the causes.

A geospatial based hotspot and regression analysis of abortion and stillbirth prevalence in Manipur, India

ABSTRACT Safe delivery of healthy newborn from the state of pregnancy is one of the main objectives of prenatal health care. Women face maternal health issues due to lack of awareness, excessive stress during pregnancies and lack of appropriate maternal health-care services. The main objectives of this research study is to identify the abortion and stillbirth prevalent hotspot zones in Manipur from the year 2011 to 2018 and identification of statistically significant factors related to the cause of abortion and stillbirth. It was observed from the hotspot results that Lamphelpat, Kakching, Thoubal, and Churachandpur are the blocks where abortion is more prevalent, whereas stillbirth cases were found to be concentrated in Lamphelpat block. Generated regression model showed good model performance with adjusted R2 = 0.68, Akaike Information Criterion (AIC) = 608.72, Moran’s I = 0.37, and adjusted R2 = 0.73, AIC = 433.26, Moran’s I = −0.05 for abortion and stillbirth, respectively. Through regression modeling three factors i.e., main worker female, female working as agriculture labor and female household worker were found to be significant for the cause maternal issues like abortion and stillbirth. There is a need to follow up pregnant women with these risk factors more frequently and in a more qualified way.

Prevalence and causes of stillbirths at a tertiary care hospital: One year study

Stillbirth is a major obstetrical complication and devastating experience for parents as well as obstetricians. Identification of causes of stillbirth will be helpful in counselling of parents as well as formulating preventive measures. Objectives of current study were to study the prevalence, causes of stillbirth and associated complications to suggest preventive measures. This retrospective observational study was carried out from July 2018 to June 2019 at a teaching tertiary care hospital. Total number of birth during the study period was 6587 and total number of stillbirth was 109, hence prevalence of stillbirth was 16.5 per 1000 total births. Majority of patients 41(37.6%) belonged to maternal age group of 20-24 years of age. Majority of patients 73(67%) were multigravida. Majority 72(66.0%) were emergency admissions. Majority of stillbirth 88(80.7%) were preterm, less than 37weeks of gestational age. Majority of stillbirth 49(44.9%) were weighted from 1000-1499gram. Majority of stillbirth 65(59.6%) were male. Vaginal delivery occurred in 93(85.3%) and 16(14.7%) required surgical intervention. In 21(19.2%) no identifiable cause of stillbirth was found whereas causes identified in 88(80.8%). Stillbirth occurred in 27(24.8%) cases of hypertensive disorder of pregnancy and 24(22%) patients of anaemia. Other causes of stillbirth were Abruption 9(8.2%), IUGR 9(8.2%), oligohydramnios 5(4.6%) congenital malformation 3(2.8%), fever 3(2.7%), placenta previa 3(2.8%), gestational diabetes 2(1.9%), hypothyroidism 2(1.9%) and uterine rupture in 1(0.9%). DIC occurred in 4(3.6%). Majority of patients were unregistered and had not taken antenatal care or had inadequate antenatal care. Hypertensive disorders during pregnancy were the leading cause for stillbirth followed by anemia and unexplained causes. A significant proportion of stillbirths can be prevented by health education regarding importance of adequate antenatal care, warning signs and institutional deliveries. Emotional support and counseling of patients and her relatives are very much essential in patients having stillbirth.

Prevalence of stillbirth and its associated factors in East Africa: generalized linear mixed modeling

BackgroundStillbirth is the most frequently reported adverse pregnancy outcome worldwide, which imposes significant psychological and economic consequences to mothers and affected families. East African countries account for one-third of the 2.6 million stillbirths globally. Though stillbirth is a common public health problem in East African countries, there is limited evidence on the pooled prevalence and associated factors of stillbirth in East Africa. Therefore, this study aimed to investigate the prevalence of stillbirth and its associated factors in East Africa.MethodsThis study was based on the most recent Demographic and Health Surveys (DHSs) of 12 East African countries. A total weighted sample of 138,800 reproductive-age women who gave birth during the study period were included in this study. The prevalence of stillbirth with the 95% Confidence Interval (CI) was reported using a forest plot. A mixed-effect binary logistic regression analysis was done to identify significantly associated factors of stillbirth. Since the DHS data has hierarchical nature, the presence of clustering effect was assessed using the Likelihood Ratio (LR) test, and Intra-cluster Correlation Coefficient (ICC), and deviance were used for model comparison. Variables with a p-value of less than 0.2 in the bi-variable analysis were considered for the multivariable analysis. In the multivariable mixed-effect binary logistic regression analysis, the Adjusted Odds Ratio (AOR) with 95% CI were reported to declare the strength and significance of the association.ResultsThe prevalence of stillbirth in East Africa was 0.86% (95% CI: 0.82, 0.91) ranged from 0.39% in Kenya to 2.28% in Burundi. In the mixed-effect analysis; country, women aged 25–34 years (AOR = 1.27, 95% CI: 1.11, 1.45), women aged ≥ 35 years (AOR = 1.19, 95% CI: 1.01, 1.44), poor household wealth (AOR = 1.07, 95% CI: 1.02, 1.23), women who didn’t have media exposure (AOR = 1.11, 95% CI: 1.01, 1.25), divorced/widowed/separated marital status (AOR = 2.99, 95% CI: 2.04, 4.39), caesarean delivery (AOR = 1.81, 95% CI: 1.52, 2.15), preceding birth interval < 24 months (AOR = 1.15, 95% CI: 1.06, 1.24), women attained secondary education or above (AOR = 0.68, 95% CI: 0.56, 0.81) and preceding birth interval ≥ 49 months (AOR = 1.45, 95% CI: 1.28, 1.65) were significantly associated with stillbirth.ConclusionsStillbirth remains a major public health problem in East Africa, which varied significantly across countries. These findings highlight the weak health care system of East African countries. Preceding birth interval, county, maternal education media exposure, household wealth status, marital status, and mode of delivery were significantly associated with stillbirth. Therefore, public health programs enhancing maternal education, media access, and optimizing birth spacing should be designed to reduce the incidence of stillbirth.

Associations Between Consumption of Coffee and Caffeinated Soft Drinks and Late Stillbirth—Findings From the Midland and North of England Stillbirth Case-Control Study

(Abstracted from Eur J Obstet Gynecol Reprod Biol 2021;256:471–477) The prevention of stillbirth is an enduring problem. Identifying risk factors and developing strategies to minimize their effect can help to reduce the prevalence of stillbirth.

Assisted reproductive technologies and the risk of stillbirth in singleton pregnancies: a systematic review and meta-analysis

To identify the risk of stillbirth from invitro types of assisted reproductive technologies compared with spontaneous conception (SC), limited to singleton births. Systematic literature search and search chaining on online databases: PubMed, Embase, and Scopus. Not applicable. Singleton pregnancies from invitro fertilization (IVF) or fertilization by IVF and intracytoplasmic sperm injection (IVF-ICSI). Not applicable. Adjusted odds ratio for stillbirth or prevalence of stillbirth in case-control groups of IVF/IVF-ICSI singletons and SCs, respectively, in matched studies. A total of 19 studies were included, and study quality was mixed. Ten studies qualified for inclusion to the meta-analysis, which revealed a significantly increased risk of stillbirth in IVF/IVF-ICSI compared with that in SC (odds ratio [95% confidence interval]: 1.82 [1.37-2.42]), and there was no evidence of publication bias. Invitro fertilization and IVF-ICSI treatment increases the risk of stillbirth compared with natural conception. PROSPERO216768.

Ursodeoxycholic acid in intrahepatic cholestasis of pregnancy: a systematic review and individual participant data meta-analysis

SummaryBackgroundUrsodeoxycholic acid is commonly used to treat intrahepatic cholestasis of pregnancy, yet its largest trial detected minimal benefit for a composite outcome (stillbirth, preterm birth, and neonatal unit admission). We aimed to examine whether ursodeoxycholic acid affects specific adverse perinatal outcomes.MethodsIn this systematic review and individual participant data meta-analysis, we searched PubMed, Web of Science, Embase, MEDLINE, CINAHL, Global Health, MIDIRS, and Cochrane without language restrictions for relevant articles published between database inception, and Jan 1, 2020, using search terms referencing intrahepatic cholestasis of pregnancy, ursodeoxycholic acid, and perinatal outcomes. Eligible studies had 30 or more study participants and reported on at least one individual with intrahepatic cholestasis of pregnancy and bile acid concentrations of 40 μmol/L or more. We also included two unpublished cohort studies. Individual participant data were collected from the authors of selected studies. The primary outcome was the prevalence of stillbirth, for which we anticipated there would be insufficient data to achieve statistical power. Therefore, we included a composite of stillbirth and preterm birth as a main secondary outcome. A mixed-effects meta-analysis was done using multi-level modelling and adjusting for bile acid concentration, parity, and multifetal pregnancy. Individual participant data analyses were done for all studies and in different subgroups, which were produced by limiting analyses to randomised controlled trials only, singleton pregnancies only, or two-arm studies only. This study is registered with PROSPERO, CRD42019131495.FindingsThe authors of the 85 studies fulfilling our inclusion criteria were contacted. Individual participant data from 6974 women in 34 studies were included in the meta-analysis, of whom 4726 (67·8%) took ursodeoxycholic acid. Stillbirth occurred in 35 (0·7%) of 5097 fetuses among women with intrahepatic cholestasis of pregnancy treated with ursodeoxycholic acid and in 12 (0·6%) of 2038 fetuses among women with intrahepatic cholestasis of pregnancy not treated with ursodeoxycholic acid (adjusted odds ratio [aOR] 1·04, 95% CI 0·35–3·07; p=0·95). Ursodeoxycholic acid treatment also had no effect on the prevalence of stillbirth when considering only randomised controlled trials (aOR 0·29, 95% CI 0·04–2·42; p=0·25). Ursodeoxycholic acid treatment had no effect on the prevalence of the composite outcome in all studies (aOR 1·28, 95% CI 0·86–1·91; p=0·22), but was associated with a reduced composite outcome when considering only randomised controlled trials (0·60, 0·39–0·91; p=0·016).InterpretationUrsodeoxycholic acid treatment had no significant effect on the prevalence of stillbirth in women with intrahepatic cholestasis of pregnancy, but our analysis was probably limited by the low overall event rate. However, when considering only randomised controlled trials, ursodeoxycholic acid was associated with a reduction in stillbirth in combination with preterm birth, providing evidence for the clinical benefit of antenatal ursodeoxycholic acid treatment.FundingTommy's, the Wellcome Trust, ICP Support, and the National Institute for Health Research.

Abnormal placental perfusion and the risk of stillbirth: a hospital-based retrospective cohort study

BackgroundA lack of information on specific and interventional factors for stillbirth has made designing preventive strategies difficult, and the stillbirth rate has declined more slowly than the neonatal death rate. We compared the prevalence of stillbirth among the offspring of women with or without abnormal placental perfusion (APP).MethodsWe conducted a hospital-based retrospective cohort study involving women with a singleton pregnancy between 2012 and 2016 (N = 41,632). Multivariate analysis was performed to compare the prevalence of stillbirth in infants exposed to APP (defined as any abnormality in right or left uterine artery pulsatility index or resistance index [UtA-PI, −RI] [e.g., > 95th percentile] or presence of early diastolic notching) with that in those not exposed to APP.ResultsStillbirths were more common among women with APP than among those with normal placental perfusion (stillbirth rate, 4.3 ‰ vs 0.9 ‰; odds ratio (OR), 4.2; 95% confidence interval (CI), 2.2 to 8.0). The association strengths were consistent across groups of infants exposed to APP that separately defined by abnormality in right or left UtA-PI or -RI (OR ranged from 3.2 to 5.3; all P ≤ 0.008). The associations were slightly stronger for the unexplained stillbirths. Most of the unexplained stillbirth risk was attributed to APP (59.0%), while a foetal sex disparity existed (94.5% for males and 58.0% for females). Women with normal placental perfusion and a male foetus had higher credibility (e.g., higher specificities) in excluding stillbirths than those with APP and a female foetus at any given false negative rate from 1 to 10% (93.4% ~ 94.1% vs. 12.3% ~ 14.0%).ConclusionsAPP is associated with and accounts for most of the unexplained stillbirth risk. Different mechanisms exist between the sexes. The performance of screening for stillbirth may be improved by stratification according to sex and placental perfusion.

Prevalence of Stillbirth and Associated Factors among Immediate Postpartum Mothers at Bahir Dar, Felegehiwot Hospital, Northwest Ethiopia: Cross-sectional Study

Background: Stillbirth rates are among the indicators of maternal and child health care quality in the countries. However, the majority of neonatal deaths and almost all stillbirths were underreported in Ethiopia. Therefore, this study aimed to determine the prevalence of stillbirth and associated factors among immediate postpartum mothers in the study area. Methods: An institution-based cross-sectional study was employed at Felegehiwot comprehensive specialized hospital from March to May 2016 (n=310). A pretested structured interviewer- administered questionnaire and medical chart reviews were used to collect data from immediate postpartum mothers. Data were entered into Epi Info version 7 and analyzed using SPSS version 20. The binary logistic regression model fitted to identify stillbirth; adjusted odds ratio (AOR) with a 95% confidence interval (CI) was computed to assess the strength of association. Variables having less than 0.05 p-value of in the multivariable considered as factors associated with stillbirths. Result: The prevalence of stillbirth was 8.7% (95%CI: 5.8, 12.4). Rural dwelling (AOR=2.86, 95%CI: 1.10 7.47), twin pregnancy (AOR=6.69, 95% CI: 1.77, 25.2), medical or obstetrical illnesses during pregnancy (AOR=5.54, 95%CI: 1.71 17.94) and complications during labor and delivery (AOR=4.96, 95%CI: 1.48 16.58) were factors associated with stillbirths. Conclusion: This study revealed that the magnitude of stillbirth was high in rural dwelling, twin pregnancy, medical or obstetrical illnesses during pregnancy, and complicated labor were associated with increased occurrences of stillbirth. This finding suggests that particular emphasis on rural dwellers and strengthening quality of Maternal in pregnancy and labor delivery service and proper following during labor attending process are mandatory to reduce stillbirth.

Pregnancy outcomes at Mizan-Tepi University Teaching Hospital: A Comparison to the Ethiopian Demographic and Health Surveys.

Background:To compare outcomes at Mizan-Tepi University Teaching Hospital to national and regional data and to plan quality improvement and research studies based on the results.Methods:This study was a prospective hospital-based cross-sectional analysis of a convenience sample of 1, 000 women who delivered at Mizan-Tepi University Teaching Hospital.Results:Our convenience sample was young (median age 24 years) with a primarily school level or less of education (68.6%). Only about 5% of women had a history of prior cesarean birth, 2.1% reported they were human immunodeficiency virus seropositive, and the median number of prenatal visits was four. Women were commonly admitted in spontaneous labor (84.5%), transferred from another facility (49.2%; 96.8% of which were referred from a health center), and had their fetal heart rate auscultated on admission (94.7%). Only 5.2% of women did not deliver within twenty-four hours and the cesarean birth prevalence was 23.4%. Many women were delivered by midwives (73.2%; all unassisted vaginal births), 89.2% were term deliveries, and 92.5% of neonatal birthweights were 2500 grams or heavier. Less than five percent of women delivered stillbirths (4.3%) and 5.7% of livebirths experienced neonatal death by the day of discharge. There were no maternal deaths in the cohort.Conclusion:The prevalence of stillbirth and neonatal death were the most notable findings, while there was no maternal death in the cohort.

Stillbirths in China: a nationwide survey

ObjectiveTo estimate a stillbirth rate at 24 or more gestational weeks in 2015–2016 and to explore potentially preventable causes in China.DesignA multi‐centre cross‐sectional study.SettingNinety‐six hospitals distributed in 24 (of 34) provinces in China.PopulationA total of 75 132 births at 24 completed weeks of gestation or more.MethodsCOX Proportional Hazard Models were performed to examine risk factors for antepartum and intrapartum stillbirths. Population attributable risk percentage was calculated for major risk factors. Correspondence analysis was used to explore region‐specific risk factors for stillbirths.Main outcome measuresStillbirth rate and risk factors for stillbirth.ResultsA total of 75 132 births including 949 stillbirths were used for the final analysis, giving a weighted stillbirth rate of 13.2 per 1000 births (95% CI 7.9–18.5). Small for gestational age (SGA) and pre‐eclampsia/eclampsia increased antepartum stillbirths by 26.2% and 11.7%, respectively. Fetal anomalies increased antepartum and intrapartum stillbirths by 17.9% and 7.4%, respectively. Overall, 31.4% of all stillbirths were potentially preventable. Advanced maternal age, pre‐pregnant obesity, chronic hypertension and diabetes mellitus were important risk factors in East China; low education and SGA were major risk factors in Northwest, Southwest, Northeast and South China; and pre‐eclampsia/eclampsia and intrapartum complications were significant risk factors in Central China.ConclusionsThe prevalence of stillbirth was 13.2 per 1000 births in China in 2015–2016. Nearly one‐third of all stillbirths may be preventable. Strategies based on regional characteristics should be considered to reduce further the burden of stillbirths in China.Tweetable abstractThe stillbirth rate was 13.2 per 1000 births in China in 2015–2016 and nearly one‐third of all stillbirths may be preventable.

Posición al dormir de la gestante y su asociación con óbito fetal

El óbito fetal, continúa siendo una condición de gran importancia a nivel mundial, siendo uno de los escenarios a los que se les debe prestar especial atención y cuidado, realizando un principal enfoque durante la atención prenatal, para así lograr objetivizar los factores de riesgo que podrían desencadenar un desenlace fatídico para la madre y el feto, y de este mismo modo modificarlos y prevenirlos, principalmente.&#x0D; El óbito fetal ha sido estudiado a lo largo de los años, en dónde se ha llegado a la conclusión que existen factores de riesgo modificables y no modificables relacionados con esta condición, de modo que se han realizado campañas para contrarrestar estas condiciones y así obtener un resultado favorable del embarazo, con un único objetivo de disminuir la recurrencia e incidencia de los óbitos fetales. Como ya se mencionó previamente, existen múltiples factores que influyen directa o indirectamente en la prevalencia del óbito, entre los cuales se destaca: la raza, comorbilidades de la madre, obesidad, tabaquismo, e inclusive en los últimos años se ha visto la relación entre la posición que la madre adopta al dormir principalmente en el último trimestre de embarazo y la prevalencia del óbito fetal, por esta razón ha sido de vital importancia estudiar este tipo de relaciones y poder evitarlas para prevenir este terrible acontecimiento.

A Healthy Lifestyle Intervention During Pregnancy: Key To Preventing Chronic Disease Risk?

Gestational hypertension disorders and diabetes affect 6-15% of all pregnancies worldwide and are associated with adverse maternal and neonatal outcomes that can have a programming effect on future chronic disease risk. Pregnant women who receive lifestyle interventions, including healthy eating and/or physical activity, may have a decreased risk of developing complications. PURPOSE: To analyze the effects of a supervised healthy lifestyle intervention (nutrition and exercise) during pregnancy on diagnosis of gestational diabetes, hypertension, caesarean delivery, stillbirth, macrosomia (babies > 4500g), and low birth weight (babies < 2500g) in a cohort in London, Canada. METHODS: From 2016 to 2019, 111 women were enrolled at 12-18 weeks gestation in the Nutrition and Exercise Lifestyle Intervention Program (NELIP; Clinical Trials #NCT02804061) up to delivery. The nutrition goals for the intervention were: 1) Submit a weekly 24 hour-food intake record; 2) Consume approximately 1800-2200 kcal/d; and 3) Consume 200-250 g carbohydrates/d (40-55% of total energy intake). The exercise goals were: 1) Duration of session: Walk for 25 minutes and add 2 minutes each week until 40 minutes were achieved and then maintain this walking duration until delivery; 2) Frequency: 3-4 times per week; and 3) Submit a weekly step log (pedometers were provided to each participant). RESULTS: As of October 2019, the average duration of the intervention was 20.9 ± 3.9 wks. Out of the 75 participants that completed the intervention, maternal age was 32.2 ± 3.3 yrs, self-reported pre-pregnancy weight was 71.2 ± 15.3 kg, and gestational age at delivery was 278.1 ± 9.0 days. No participants were diagnosed with gestational diabetes or hypertension. Data from 52 babies indicated: birth weight was 3456.0 ± 442.4 g and length was 50.7 ± 3.1 cm. None were born with low birth weight and there were no cases of stillbirth. The rate of macrosomia was 1.9% (n = 1) and caesarean delivery was 27% (n = 14). CONCLUSION: A healthy lifestyle intervention during pregnancy may help to prevent gestational diabetes and hypertension, and help to reduce the prevalence of stillbirth, macrosomia, low birth weight, and caesarean deliveries. Taken together, these findings may have major positive implications for the long-term health of both mothers and babies.

Nkx2.1 downregulation is involved in brain abnormality induced by excess retinoic acid.

Abnormal development of central nervous system (CNS) caused by neural tube defects is not only a major contributor in the prevalence of stillbirths and neonatal deaths but also causes lifelong physical disability in surviving infants. Due to insufficient known investigated causes, CNS developmental abnormality has brought sever burden on health around the world. From previous results of high throughput transcriptome sequencing, we selected transcription factor Nkx2.1 as a candidate to investigate its role on brain abnormalities induced by excessive retinoic acid. The result of in situ hybridization showed that Nkx2.1 was mainly expressed in mouse brain. After the Nkx2.1 gene was silenced, retarded proliferation and accelerated apoptosis were found in mouse Neuro-2a (N2a) cells. Furthermore, our results indicated that the main components of sonic hedgehog (Shh) signaling pathway were affected in Nkx2.1-silenced cells, implying that Nkx2.1 plays an important role in the development of mouse brain by regulating Shh signaling pathway.

Ethionine Suppresses Mitochondria Autophagy and Induces Apoptosis via Activation of Reactive Oxygen Species in Neural Tube Defects.

Abnormal development of central nervous system (CNS) caused by neural tube defects (NTDs) is not only remained the major contributor in the prevalence of stillbirths and neonatal deaths, but also represents a significant cause of lifelong physical disability in the surviving infants. Ethionine is a non-proteinogenic amino acid and antagonist of methionine. Methionine cycle is essential for the elimination of reactive oxygen species (ROS), while lysosomes are involved in the initiation of autophagy. However, its role in ethionine-induced cell death in neural tube defects, still need to be explored. In this study, we investigated the effect of ethionine on NTDs as well as the underlying mechanism involved in this process. Following the establishment of NTDs model using ethionine-induced C57BL/6 mice, ethionine was intraperitoneally injected at a dose of 500 mg/kg in E7.5. Our study revealed that ethionine has induced mitochondrial apoptosis in NTDs by reducing mitochondrial autophagy both in vivo and in vitro. These results provided a possible molecular mechanism for redox regulation of autophagic process.

Medical and social significance of abortion in the Russian Federation

Abortion in Russia is an urgent problem with high medical and social significance due to high prevalence and significant contribution to reproductive losses, maternal mortality and gynecological morbidity. Aim. To assess the dynamics and pattern of abortion in Russia for 2008-2015. Material and methods. The official statistics were analyzed using the descriptive statistic methods. Results. Between 2008 and 2015, the total number of abortions decreased by 39,6%. The number of social abortions has decreased the most — by 96,7%, criminal abortions — by 87,0%, medical (legal) abortions — by 53,8%, unspecified abortions — by 40,5%, therapeutic abortions — by 9,7%. The number of spontaneous abortions, on the contrary, increased by 34,6%. Conclusion. Despite the fact that number of abortions has decreased, it remains high. Moreover, the prevalence of spontaneous abortions has increased. At the same time, the proportion of spontaneous abortions in pregnancies resulted in births in 2015 amounted to 12,3%. It indicates an increase in their prevalence and contribution to female fertility defects.

Pregnancy outcomes in interferon-beta-exposed patients with multiple sclerosis: results from the European Interferon-beta Pregnancy Registry

BackgroundFamily planning is an important consideration for women with multiple sclerosis (MS), who are often diagnosed during their reproductive years. Currently, limited data are available on pregnancy outcomes in patients exposed to interferon-beta (IFN-beta) before or during pregnancy. Here, we present the cumulative pregnancy exposure data and prevalence of pregnancy and infant outcomes in IFN-beta-exposed pregnant women with MS from the European IFN-beta Pregnancy Registry.MethodsUsing spontaneous and solicited reports, the registry collected data from 26 countries of the European Economic Area, consisting of information on women with MS identifying themselves to one of the Marketing Authorisation Holders (Bayer, Biogen, Merck KGaA, and Novartis) or healthcare professionals as pregnant and exposed to IFN-beta during pregnancy or within 1 month before conception. The outcomes collected by the registry included ectopic pregnancies, spontaneous abortions, elective terminations, live, and stillbirths with or without congenital anomalies. The prevalence of pregnancy outcomes was put in context with those reported in the general population.ResultsBetween 2009 and 2017, the registry collected 948 pregnancy reports with a known pregnancy outcome. Overall, 82.0% (777/948) of pregnancies resulted in live birth without congenital anomaly. When comparing IFN-beta-exposed pregnancies with the general population, the prevalence of spontaneous abortions (10.7% vs. 10–21%) and congenital anomalies in live births (2.1% vs. 2.1–4.1%) were found to be within reported ranges.ConclusionsThe data gathered from these pregnancy cases suggest no evidence that IFN-beta exposure before conception and/or during pregnancy adversely increases the rate of congenital anomalies or spontaneous abortions.

Safety of MenACWY-CRM vaccine exposure during pregnancy

BackgroundAlthough the meningococcal conjugate MenACWY-CRM vaccine is not approved for use in pregnant women, unintentional exposure during pregnancy can occur, especially during early pregnancy among women of child-bearing age. This study provides safety information about inadvertent MenACWY-CRM vaccination during pregnancy. MethodsThe evaluated population consisted of pregnant female members of Kaiser Permanente Southern California who inadvertently received MenACWY-CRM at 11–21 years of age during 09/30/2011-06/30/2013 within 28 days prior to conception or during pregnancy. Chart abstraction was conducted to identify pregnancy and birth outcomes, including spontaneous and induced abortions, preterm births, low weight births, and major congenital malformations (MCMs). ResultsThere were 92 women who received MenACWY-CRM during the pregnancy exposure period, mainly during the first trimester (76.1%). Hispanics represented the largest race/ethnicity category (68.5%). Among the known pregnancy outcomes (n = 66; excluding induced abortions and unknown pregnancy outcomes), the prevalence of spontaneous abortions was 18.2% (n = 12). Among live born infants (n = 55; from 54 pregnancies), 14.5% (n = 8) were born preterm (<37 weeks gestation) and 9.1% (n = 5) had a low birthweight (<2500 g). The prevalence rate of MCMs among live born infants (n = 55) was 1.8% (n = 1). ConclusionsThis study provides baseline prevalence estimates of spontaneous abortions, preterm births, low weight births, and MCMs among women inadvertently exposed to MenACWY-CRM during the pregnancy period. These estimates appear to be comparable with U.S. background prevalence estimates.

Prelabor rupture of membranes and the association with cerebral palsy in term born children: a national registry-based cohort study

BackgroundGuidelines regarding management of prelabor rupture of membranes (PROM) at term vary between immediate induction and expectant management. A long interval between PROM and delivery increases the risk for perinatal infections. Severe perinatal infections are associated with excess risk for cerebral palsy (CP) and perinatal death. We investigated if increasing intervals between PROM and delivery were associated with perinatal death or CP.MethodsEligible to participate in this population-based cohort-study were term born singletons without congenital malformations born in Norway during 1999–2009. Data was retrieved from the Medical Birth Registry of Norway (MBRN) and the Cerebral Palsy Register of Norway. In line with the registration in the MBRN, intervals between PROM and delivery of more than 24 h was defined as ‘prolonged’ and intervals between 12 and 24 h as ‘intermediate’. Outcomes were stillbirth, death during delivery, neonatal mortality and CP. Logistic regression was used to calculate odds ratio (OR) with 95% confidence intervals (CI) for adverse outcomes in children born after prolonged and intermediate intervals, compared with a reference group comprising all children born less than 12 h after PROM or without PROM.ResultsAmong 559,972 births, 34,759 children were born after intermediate and 30,332 were born after prolonged intervals. There was no association between increasing intervals and death during delivery or in the neonatal period, while the prevalence of stillbirths decreased with increasing intervals. Among children born after intermediate intervals 38 (0.11%) had CP, while among those born after prolonged intervals 46 (0.15%) had CP. Compared with the reference group, the OR for CP was 1.16 (CI; 0.83 to 1.61) after intermediate and 1.61 (CI; 1.19 to 2.18) after prolonged intervals. Adjusting for antenatal factors did not affect these associations. Among children with CP the proportion with diffuse cortical injury and basal ganglia pathology on cerebral MRI, consistent with hypoxic-ischemic injuries, increased with increasing intervals.ConclusionIntervals between PROM and delivery of more than 24 h were associated with CP, but not with neonatal mortality or death during delivery. The inverse association with stillbirth is probably due to reverse causality.

The trend and characteristics of stillbirth delivery in a university teaching hospital in Lagos, Nigeria.

Background:The burden of stillbirth is so huge in sub-Saharan Africa, especially in Nigeria where many mothers and mothers-to-be are denied the joy of motherhood. Despite the frequent occurrence of this obstetric problem in our environment, little priority is placed on it.Objectives:The study aims to bring to the fore, the burden, trend, and characteristics of stillbirth delivery in Lagos, Nigeria.Subjects and Methods:This was a 5-year descriptive retrospective study of the case records of women who had stillbirth delivery at Lagos University Teaching Hospital from January 2009 to December 2013. Relevant information was obtained using a study pro forma, and data analysis was carried out using SPSS version 20.0.Results:The prevalence of stillbirth was 6.2%, and the rate was 61.8/1000 total births. Women who did not book for antenatal care accounted for 76.2% of the cases, and the antenatal and intrapartum stillbirths accounted for 64.6% and 35.4%, respectively. The mean gestational age was 35.5 ± 1.2 weeks, while the mean birth weight was 2.9 ± 1.0 kg. Majority of the stillbirths were male fetuses (54.5%). Previous history of stillbirth (36.0%), hypertensive disorders in pregnancy (33.0%), placental abruption (28.8%), intrauterine growth restriction (13.0%), and ruptured uterus (11.3%) were the common clinical risk factors identified.Conclusion:The burden of stillbirth is high in our environment, and majority is due to preventable or manageable obstetric conditions. There is a need to encourage early referral of complicated pregnancies and labor to specialized centers that can cater for them, so as to avoid unnecessary and preventable deaths.